Li Bin, Dai Yuchen, Cai Wenlan, Sun Menghan, Sun Jie
Department of Anesthesiology, Zhongda hospital, Southeast University, No. 87 Dingjiaqiao, Nanjing City, 210009, Jiangsu Province, China.
Southeast University School of Medicine, No. 87 Dingjiaqiao, Nanjing City, 210009, Jiangsu Province, China.
J Cardiothorac Surg. 2025 Jan 27;20(1):100. doi: 10.1186/s13019-025-03353-6.
Monitoring perioperative tissue perfusion is crucial in clinical anesthesia to protect organs and ensure patient safety. Indicators like hemodynamic parameters, tissue metabolism, and microcirculation markers are used for assessment. Studies show intraoperative hypotension negatively impacts outcomes, though blood pressure alone may not reflect tissue perfusion accurately. Cardiac output is a more direct measure, with adequate levels generally indicating good perfusion. However, some conditions cause adequate cardiac output but inadequate perfusion. Non-quantitative markers like skin color and temperature, and quantitative indicators like tissue oxygen saturation and laser Doppler flowmetry, help assess microcirculation but can't fully evaluate systemic perfusion. Near-Infrared Spectroscopy (NIRS) monitors tissue oxygen metabolism, reflecting oxygen supply and consumption balance. Central venous oxygen saturation offers a better systemic overview but may not always indicate good perfusion, especially in sepsis. Lactic acid levels closely correlate with tissue perfusion and outcomes, with dynamic changes being more indicative than single measurements. Effective monitoring requires evaluating both macro- and microcirculation states and systemic metabolic levels to ensure optimal outcomes. Combining these measures provides a more accurate assessment of tissue perfusion and patient prognosis.
围手术期组织灌注监测在临床麻醉中对于保护器官和确保患者安全至关重要。诸如血流动力学参数、组织代谢和微循环标志物等指标被用于评估。研究表明，术中低血压会对预后产生负面影响，尽管仅血压可能无法准确反映组织灌注情况。心输出量是一种更直接的测量方法，其水平充足通常表明灌注良好。然而，某些情况会导致心输出量充足但灌注不足。诸如皮肤颜色和温度等非定量标志物，以及诸如组织氧饱和度和激光多普勒血流仪等定量指标，有助于评估微循环，但无法全面评估全身灌注。近红外光谱（NIRS）监测组织氧代谢，反映氧供需平衡。中心静脉血氧饱和度能提供更好的全身概况，但并不总是表明灌注良好，尤其是在脓毒症中。乳酸水平与组织灌注和预后密切相关，动态变化比单次测量更具指示性。有效的监测需要评估宏观和微循环状态以及全身代谢水平，以确保获得最佳结果。综合这些措施可更准确地评估组织灌注和患者预后。
