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重度肺动脉高压患者的术中目标导向麻醉管理

Intraoperative Goal-Directed Anesthetic Management of the Patient with Severe Pulmonary Hypertension.

作者信息

Liu Jinhong, Nahrwold Daniel A, Serdiuk Andrew A, Koontz Dave B, Fontaine Jacques-Pierre

机构信息

Department of Anesthesia, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.

Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.

出版信息

Am J Case Rep. 2019 Jul 11;20:998-1001. doi: 10.12659/AJCR.916330.

DOI:10.12659/AJCR.916330
PMID:31292431
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6640173/
Abstract

BACKGROUND It is very challenging for anesthesiologists to manage patients with pulmonary hypertension undergoing general anesthesia for elective or emergent surgeries. CASE REPORT We present a patient with severe pulmonary hypertension going through a major robotic thoracic surgery. CONCLUSIONS A goal-directed anesthesia management algorithm based on serial stroke volume (SV) values obtained from FloTrac (Edwards Lifesciences, LLC.) minimally invasive arterial pressure sensor was utilized in an attempt to reduce the anesthetic and surgical risk associated with severe pulmonary hypertension.

摘要

背景

对于麻醉医生来说，管理患有肺动脉高压的患者接受择期或急诊手术的全身麻醉极具挑战性。

病例报告

我们介绍了一位患有严重肺动脉高压并接受大型机器人辅助胸外科手术的患者。

结论

采用了一种基于从爱德华生命科学有限责任公司的FloTrac微创动脉压传感器获得的连续每搏量（SV）值的目标导向麻醉管理算法，试图降低与严重肺动脉高压相关的麻醉和手术风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3946/6640173/c957aa28f20f/amjcaserep-20-998-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3946/6640173/c957aa28f20f/amjcaserep-20-998-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3946/6640173/c957aa28f20f/amjcaserep-20-998-g001.jpg

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本文引用的文献

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Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial.经胸食管切除术时目标导向治疗并未改善预后：随机对照试验。
Eur J Anaesthesiol. 2019 Feb;36(2):153-161. doi: 10.1097/EJA.0000000000000908.
2
Perioperative goal-directed therapy: A systematic review without meta-analysis.围术期目标导向治疗：一项无荟萃分析的系统评价。
Acta Anaesthesiol Scand. 2018 Nov;62(10):1340-1355. doi: 10.1111/aas.13212. Epub 2018 Jul 6.
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National Trends in Use and Outcomes of Pulmonary Artery Catheters Among Medicare Beneficiaries, 1999-2013.
FloTrac™ 传感器在全肺切除术后腹腔镜手术麻醉管理中的应用：病例报告及文献复习。
Am J Case Rep. 2020 Dec 4;21:e925979. doi: 10.12659/AJCR.925979.
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JAMA Cardiol. 2017 Aug 1;2(8):908-913. doi: 10.1001/jamacardio.2017.1670.
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Stroke Volume Variation and Pulse Pressure Variation Are Not Useful for Predicting Fluid Responsiveness in Thoracic Surgery.在胸外科手术中，每搏量变异和脉压变异不能用于预测液体反应性。
Anesth Analg. 2017 Oct;125(4):1158-1165. doi: 10.1213/ANE.0000000000002056.
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Effects of Intraoperative Fluid Management on Postoperative Outcomes: A Hospital Registry Study.术中液体管理对术后结局的影响：医院登记研究。
Ann Surg. 2018 Jun;267(6):1084-1092. doi: 10.1097/SLA.0000000000002220.
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Variation in Hospital Use and Outcomes Associated With Pulmonary Artery Catheterization in Heart Failure in the United States.美国心力衰竭患者肺动脉导管插入术相关的医院使用情况及预后差异
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Ongoing Use of Pulmonary Artery Catheters Despite Negative Trial Findings.尽管试验结果为阴性，但肺动脉导管仍在持续使用。
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