Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Department of Anesthesiology and Pain Management, Baylor University Medical Center, Dallas, TX.
J Cardiothorac Vasc Anesth. 2019 Aug;33 Suppl 1:S67-S72. doi: 10.1053/j.jvca.2019.03.043.
Hemodynamic monitoring is an essential part of the perioperative management of the cardiovascular patient. It helps to detect hemodynamic alterations, diagnose their underlying causes, and optimize oxygen delivery to the tissues. Furthermore, hemodynamic monitoring is necessary to evaluate the adequacy of therapeutic interventions such as volume expansion or vasoactive medications. Recent developments include the move from static to dynamic variables to assess conditions such as cardiac preload and fluid responsiveness and the transition to less-invasive or even noninvasive monitoring techniques, at least in the perioperative setting. This review describes the available techniques that currently are being used in the care of the cardiovascular patient and discusses their strengths and limitations. Even though the thermodilution method remains the gold standard for measuring cardiac output (CO), the use of the pulmonary artery catheter has declined over the last decades, even in the setting of cardiovascular anesthesia. The transpulmonary thermodilution method, in addition to accurately measuring CO, provides the user with some additional helpful variables, of which extravascular lung water is probably the most interesting. Less-invasive monitoring techniques use, for example, pulse contour analysis to originate flow-derived variables such as stroke volume and CO from the arterial pressure signal, or they may measure the velocity-time integral in the descending aorta to estimate the stroke volume, using, for example, the esophageal Doppler. Completely noninvasive methods such as the volume clamp method use finger cuffs to reconstruct the arterial pressure waveform, from which stroke volume and CO are calculated. All of these less-invasive CO monitoring devices have percentage errors around 40% compared with reference methods (thermodilution), meaning that the values are not interchangeable.
血流动力学监测是心血管患者围手术期管理的重要组成部分。它有助于发现血流动力学改变，诊断其根本原因，并优化组织氧输送。此外，血流动力学监测对于评估治疗干预措施的充分性也是必要的，如容量扩张或血管活性药物。最近的发展包括从静态变量转向动态变量来评估心脏前负荷和液体反应性等情况，以及转向微创甚至非侵入性监测技术，至少在围手术期环境中是如此。这篇综述描述了目前在心血管患者护理中使用的可用技术，并讨论了它们的优缺点。尽管热稀释法仍然是测量心输出量（CO）的金标准，但肺动脉导管的使用在过去几十年中有所下降，即使在心血管麻醉中也是如此。经肺热稀释法除了准确测量 CO 外，还为用户提供了一些额外的有用变量，其中血管外肺水可能是最有趣的。微创监测技术例如使用脉搏轮廓分析从动脉压力信号中衍生出流量相关变量，如每搏量和 CO，或者可以测量降主动脉中的速度-时间积分来估计每搏量，例如使用食管多普勒。完全非侵入性方法，如容积钳法，使用手指袖带重建动脉压力波形，从该波形中计算出每搏量和 CO。与参考方法（热稀释法）相比，所有这些微创 CO 监测设备的百分比误差约为 40%，这意味着这些值不能互换。
