St Georges Hospital, London, UK.
Anaesthesia. 2017 Jan;72 Suppl 1:7-15. doi: 10.1111/anae.13737.
Over recent years there has been an increase in the implementation of goal-directed therapy using minimally invasive haemodynamic monitoring techniques to guide peri-operative care. Since the introduction of the pulmonary artery flotation catheter in the 1980s, various haemodynamic monitors have been developed, each associated with their own benefits and limitations. Goal-directed therapy has been well-established as a standard of care in the peri-operative period and has largely been associated with a reduction in morbidity and mortality. However, evidence over the last few years from major studies has led us to question: what is the future for goal-directed therapy? Care of the peri-operative patient has significantly evolved over the last decade and this needs to be taken into account when assessing the results of these studies. We should therefore not look at the effects of goal-directed therapy in isolation but as part of a progressive care bundle. Additionally, other markers of haemodynamic status have also begun to be further appreciated and these are worthy of further investigation. We feel that the future for haemodynamic monitoring remains promising with new areas of interest continuously emerging, but further research is still required.
近年来，通过使用微创血流动力学监测技术来指导围手术期护理，目标导向治疗的实施有所增加。自 20 世纪 80 年代肺动脉漂浮导管问世以来，已经开发出各种血流动力学监测器，每种监测器都有其自身的优点和局限性。目标导向治疗已成为围手术期护理的标准，并且在很大程度上与降低发病率和死亡率相关。但是，近年来来自主要研究的证据使我们质疑：目标导向治疗的未来是什么？过去十年中，围手术期患者的护理有了显著的发展，在评估这些研究的结果时需要考虑到这一点。因此，我们不应孤立地看待目标导向治疗的效果，而应将其视为渐进性护理包的一部分。此外，人们也开始进一步认识到其他血流动力学状态的标志物，这些标志物值得进一步研究。我们认为血流动力学监测的未来仍然很有希望，新的研究领域不断涌现，但仍需要进一步的研究。
