aDivision of Pulmonary, Critical Care, and Sleep, Department of Medicine bDepartment of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, USA.
Curr Opin Crit Care. 2017 Jun;23(3):223-231. doi: 10.1097/MCC.0000000000000407.
We will briefly review the classification of shock and the hallmark features of each subtype. Available modalities for monitoring shock patients will be discussed, along with evidence supporting the use, common pitfalls, and practical considerations of each method.
As older, invasive monitoring methods such as the pulmonary artery catheter have fallen out of favor, newer technologies for cardiac output estimation, echocardiography, and noninvasive tests such as passive leg raising have gained popularity. Newer forms of minimally invasive or noninvasive monitoring (such as pulse contour analysis and chest bioreactance) show promise but will need further investigation before they are considered validated for practical use. There remains no 'ideal' test or standard of care for cardiopulmonary monitoring of shock patients.
Shock has potentially reversible causes of morbidity and mortality if appropriately diagnosed and managed. Older methods of invasive monitoring have significant limitations but are still critical for managing shock in certain patients and settings. Newer methods are easier to employ, but further validation is needed. Multiple modalities along with careful clinical assessment are often useful in distinguishing shock subtypes. Best practice standards for monitoring should be based on institutional expertise.
我们将简要回顾休克的分类以及各亚型的显著特征。本文将讨论休克患者的监测手段，并阐述其适应证、常见误区及实际应用中的注意事项。
随着肺动脉导管等传统、有创的监测手段逐渐失宠，心输出量评估、超声心动图以及被动抬腿等新技术得到了广泛应用。脉搏轮廓分析和胸腔生物电抗等新型微创或无创监测手段具有广阔的应用前景，但在其被广泛应用于临床实践之前，还需要进一步研究。休克患者心肺监测目前仍没有“理想”的检测方法或标准。
如果及时诊断和治疗，休克由潜在的可治愈病因引起，死亡率较高。虽然传统的有创监测手段存在明显的局限性，但在某些特定患者和环境下，它们对于休克的管理仍然至关重要。新型监测手段虽然应用更加便捷，但仍需要进一步验证。多种监测手段结合仔细的临床评估，对于休克亚型的鉴别通常具有重要意义。监测的最佳实践标准应基于机构专业知识。
