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以目标导向治疗改善低资源环境下的围手术期护理：叙事性综述。

Improving perioperative care in low-resource settings with goal-directed therapy: a narrative review.

机构信息

Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.

出版信息

Braz J Anesthesiol. 2024 Mar-Apr;74(2):744460. doi: 10.1016/j.bjane.2023.08.004. Epub 2023 Aug 28.

DOI:10.1016/j.bjane.2023.08.004
PMID:37648078
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10963926/
Abstract

Perioperative Goal-Directed Therapy (PGDT) has significantly showed to decrease complications and risk of death in high-risk patients according to numerous meta-analyses. The main goal of PGDT is to individualize the therapy with fluids, inotropes, and vasopressors, during and after surgery, according to patients' needs in order to prevent organic dysfunction development. In this opinion paper we aimed to focus a discussion on possible alternatives to invasive hemodynamic monitoring in low resource settings.

摘要

围术期目标导向治疗（PGDT）在大量荟萃分析中显著显示可降低高危患者的并发症发生率和死亡率。PGDT 的主要目标是根据患者的需求在手术期间和手术后个体化治疗液体、正性肌力药和血管加压药，以预防器官功能障碍的发生。在本意见文中，我们旨在讨论在资源有限的情况下替代有创血流动力学监测的可能方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8098/10963926/e31752a821ac/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8098/10963926/b33f5f9de787/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8098/10963926/e31752a821ac/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8098/10963926/b33f5f9de787/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8098/10963926/e31752a821ac/gr2.jpg

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本文引用的文献

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J Clin Anesth. 2022 Sep;80:110752. doi: 10.1016/j.jclinane.2022.110752. Epub 2022 Apr 8.
2
Value of variation of end-tidal carbon dioxide for predicting fluid responsiveness during the passive leg raising test in patients with mechanical ventilation: a systematic review and meta-analysis.被动抬腿试验中潮气末二氧化碳变化预测机械通气患者液体反应性的价值：系统评价和荟萃分析。
Crit Care. 2022 Jan 14;26(1):20. doi: 10.1186/s13054-022-03890-9.
3
Central Venous-to-Arterial CO2 Difference-Assisted Goal-Directed Hemodynamic Management During Major Surgery-A Randomized Controlled Trial.
中心静脉-动脉二氧化碳分压差指导下的目标导向性血流动力学管理在大型手术中的应用：一项随机对照试验。
Anesth Analg. 2022 May 1;134(5):1010-1020. doi: 10.1213/ANE.0000000000005833.
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.拯救脓毒症运动：2021年脓毒症和脓毒性休克国际管理指南
Crit Care Med. 2021 Nov 1;49(11):e1063-e1143. doi: 10.1097/CCM.0000000000005337.
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Perioperative hemodynamic optimization: from guidelines to implementation-an experts' opinion paper.围手术期血流动力学优化：从指南到实施——专家意见论文
Ann Intensive Care. 2021 Apr 14;11(1):58. doi: 10.1186/s13613-021-00845-1.
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Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery.围手术期液体管理与术后结局的关系：20 年系统评价和主要内脏/非心脏手术中目标导向性随机试验的荟萃分析。
Crit Care. 2021 Feb 1;25(1):43. doi: 10.1186/s13054-021-03464-1.
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J Crit Care. 2021 Apr;62:271-275. doi: 10.1016/j.jcrc.2020.12.021. Epub 2020 Dec 26.
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