Medikonda Ravi, Ong Chin Siang, Wadia Rajeev, Goswami Dheeraj, Schwartz Jamie, Wolff Larry, Hibino Narutoshi, Vricella Luca, Barodka Viachaslau, Steppan Jochen
1 Johns Hopkins School of Medicine, Baltimore, MD, USA.
2 Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
World J Pediatr Congenit Heart Surg. 2018 Sep;9(5):565-572. doi: 10.1177/2150135118775964.
Cardiopulmonary bypass perfusion management significantly affects postoperative outcomes. In recent years, the principles of goal-directed therapy have been applied to the field of cardiothoracic surgery to improve patient outcomes. Goal-directed therapy involves continuous peri- and postoperative monitoring of vital clinical parameters to tailor perfusion to each patient's specific needs. Closely measured parameters include fibrinogen, platelet count, lactate, venous oxygen saturation, central venous oxygen saturation, mean arterial pressure, perfusion flow rate, and perfusion pulsatility. These parameters have been shown to influence postoperative fresh frozen plasma transfusion rate, coagulation state, end-organ perfusion, and mortality. In this review, we discuss the recent paradigm shift in pediatric perfusion management toward goal-directed perfusion.
体外循环灌注管理对术后结果有显著影响。近年来，目标导向治疗原则已应用于心胸外科领域以改善患者预后。目标导向治疗包括在围手术期和术后持续监测重要临床参数，以便根据每位患者的具体需求调整灌注。密切监测的参数包括纤维蛋白原、血小板计数、乳酸、静脉血氧饱和度、中心静脉血氧饱和度、平均动脉压、灌注流速和灌注搏动性。这些参数已被证明会影响术后新鲜冰冻血浆输注率、凝血状态、终末器官灌注和死亡率。在本综述中，我们讨论了小儿灌注管理向目标导向灌注的近期范式转变。
