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心脏手术患者的重症监护治疗:聚焦于血流动力学

[Intensive care treatment of cardiac surgery patients: focus on hemodynamics].

作者信息

Görler Heidi

机构信息

Klinik für Herz‑, Thorax‑, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.

出版信息

Anaesthesiologie. 2025 Jan;74(1):52-60. doi: 10.1007/s00101-024-01497-z.

Abstract

Hemodynamic treatment is a core task in the intensive medical care of cardiac surgery patients. The patient's underlying disease, the type of surgical procedure and the patient's individual characteristics play key roles in the selection of the treatment regimen. The basis of any targeted hemodynamic treatment is the differential diagnosis of the underlying pathological disorder. The established basic monitoring can be expanded if necessary. Postoperative circulatory dysfunction can occur as low cardiac output syndrome (LCOS) predominantly with left or right heart failure or as vasoplegic syndrome (VS). In addition to catecholamines in the narrow sense, various vasoactive and inotropic substances are available for treatment. Knowledge of the recommended target parameters and indication-appropriate monitoring are essential. This article summarizes the current guideline recommendations for the treatment of postoperative circulatory dysfunction.

摘要

血流动力学治疗是心脏手术患者重症监护中的核心任务。患者的基础疾病、手术方式类型以及患者的个体特征在治疗方案的选择中起着关键作用。任何针对性血流动力学治疗的基础都是对潜在病理紊乱的鉴别诊断。如有必要,可扩展已确立的基本监测。术后循环功能障碍可表现为主要伴有左心或右心衰竭的低心排血量综合征(LCOS)或血管麻痹综合征(VS)。除了狭义的儿茶酚胺外,还有各种血管活性和正性肌力物质可用于治疗。了解推荐的目标参数和适应证合适的监测至关重要。本文总结了目前关于术后循环功能障碍治疗的指南建议。

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