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床旁超声在血流动力学评估中的应用

Point-of-Care Ultrasound Use in Hemodynamic Assessment.

作者信息

Noor Ahmed, Liu Margaret, Jarman Alan, Yamanaka Travis, Kaul Malvika

机构信息

Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.

Division of Academic Internal Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.

出版信息

Biomedicines. 2025 Jun 10;13(6):1426. doi: 10.3390/biomedicines13061426.

Abstract

Hemodynamic assessment is critical in emergency and critical care for preventing, diagnosing, and managing shock states that significantly affect patient outcomes. Point-of-care ultrasound (POCUS) has become an invaluable, non-invasive, real-time, and reproducible tool for bedside decision-making. Advancements such as Doppler imaging, advanced critical care ultrasonography, and transesophageal echocardiography (TEE) have expanded its utility, enabling rapid and repeatable evaluations, especially in complex mixed shock presentations. This review explores the role of POCUS in hemodynamic monitoring, emphasizing its ability to assess cardiac output, filling pressures, and vascular congestion, facilitating shock classification and guiding fluid management. We highlight an extensive array of POCUS techniques for evaluating right and left cardiac function and review existing literature on their advantages, limitations, and appropriate clinical applications. Beyond assessing volume status, this review discusses the role of POCUS in predicting fluid responsiveness and supporting more individualized, precise management strategies. Ultimately, while POCUS is a powerful tool for rapid, comprehensive hemodynamic assessment in acute settings, its limitations must be acknowledged and thoughtfully integrated into clinical decision-making.

摘要

血流动力学评估在急诊和重症监护中对于预防、诊断和处理显著影响患者预后的休克状态至关重要。床旁即时超声检查(POCUS)已成为一种用于床边决策的宝贵、非侵入性、实时且可重复的工具。诸如多普勒成像、高级重症监护超声检查和经食管超声心动图(TEE)等技术进步扩展了其用途,能够进行快速且可重复的评估,尤其是在复杂的混合性休克表现中。本综述探讨了POCUS在血流动力学监测中的作用,强调其评估心输出量、充盈压和血管充血情况的能力,有助于休克分类并指导液体管理。我们重点介绍了一系列用于评估左右心功能的POCUS技术,并回顾了关于它们的优势、局限性及适当临床应用的现有文献。除了评估容量状态外,本综述还讨论了POCUS在预测液体反应性以及支持更个体化、精确的管理策略方面的作用。最终,虽然POCUS是急性情况下进行快速、全面血流动力学评估的有力工具,但必须认识到其局限性并谨慎地将其纳入临床决策。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b7d/12189778/1f2828f61ea3/biomedicines-13-01426-g001.jpg

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