Laher Abdullah E, Watermeyer Matthew J, Buchanan Sean K, Dippenaar Nicole, Simo Nelly Clotilde Tchouambou, Motara Feroza, Moolla Muhammed
Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
Am J Emerg Med. 2017 Sep;35(9):1335-1347. doi: 10.1016/j.ajem.2017.03.036. Epub 2017 Mar 18.
The emergency department (ED) is frequently the doorway to the intensive care unit (ICU) for a significant number of critically ill patients presenting to the hospital. Hemodynamic monitoring (HDM) which is a key component in the effective management of the critically ill patient presenting to the ED, is primarily concerned with assessing the performance of the cardiovascular system and determining the correct therapeutic intervention to optimise end-organ oxygen delivery. The spectrum of hemodynamic monitoring ranges from simple clinical assessment and routine bedside monitoring to point of care ultrasonography and various invasive monitoring devices. The clinician must be aware of the range of available techniques, methods, interventions and technological advances as well as possess a sound approach to basic hemodynamic monitoring prior to selecting the optimal modality. This article comprises an in depth discussion of an approach to hemodynamic monitoring techniques and principles as well as methods of predicting fluid responsiveness as it applies to the ED clinician. We review the role, applicability and validity of various methods and techniques that include; clinical assessment, passive leg raising, blood pressure, finger based monitoring devices, the mini-fluid challenge, the end-expiratory occlusion test, central venous pressure monitoring, the pulmonary artery catheter, ultrasonography, bioreactance and other modern invasive hemodynamic monitoring devices.
急诊科（ED）常常是众多危重症患者进入重症监护病房（ICU）的通道。血流动力学监测（HDM）是急诊科危重症患者有效管理的关键组成部分，主要关注评估心血管系统的功能，并确定正确的治疗干预措施以优化终末器官的氧输送。血流动力学监测的范围从简单的临床评估和常规床边监测到床旁即时超声检查以及各种有创监测设备。临床医生在选择最佳监测方式之前，必须了解可用技术、方法、干预措施和技术进展的范围，并掌握基本血流动力学监测的合理方法。本文深入讨论了血流动力学监测技术和原理的方法，以及适用于急诊科临床医生的预测液体反应性的方法。我们回顾了各种方法和技术的作用、适用性和有效性，包括：临床评估、被动抬腿试验、血压、基于手指的监测设备、小型液体冲击试验、呼气末阻断试验、中心静脉压监测、肺动脉导管、超声检查、生物电阻抗以及其他现代有创血流动力学监测设备。
