机械通气患者容量反应性评估策略  

Assessment of volume responsiveness during mechanical ventilation

作　　者：刘新秀[1] 张鲁涛[1] 阎锡新[1] 

机构地区：[1]河北医科大学第二医院呼吸一科河北省呼吸病研究所,石家庄050000

出　　处：《国际呼吸杂志》2014年第A01期50-55,共6页International Journal of Respiration

基　　金：河北省自然基金课题（H2012206110）

摘　　要：对于急性循环衰竭患者，特别是感染性休克患者，液体治疗对于血流动力学的稳定、组织器官的血流灌注、纠正细胞缺氧、对抗感染十分重要，但过多增加液体量对危重症患者，特别是脓毒血症和／或肺损伤患者是有害的，如何选取合适的指标指导临床合理输液仍面临许多挑战。评估容量反应性可避免盲目补液，降低补液风险。回顾关于评估容量反应性的指标及临床报道，静态血流动力学参数，如中心静脉压、肺毛细血管楔压，虽常用但受干扰因素多，无法及时准确地评估循环血容量的变化。基于心肺相互作用的功能性血流动力学监测指标，如脉压变异和每搏量变异，虽广泛应用，但因自主呼吸、心律失常、低潮气量或低肺顺应性等局限性，不能用于所有患者。呼气末屏气试验、微量静脉输液、被动抬腿试验成为有自主呼吸运动和／或心律失常情况下评估容量反应性的备选方法，其可靠性及局限性值得进一步研究。For patients with acute circulatory failure, particularly with septic shock, fluid administration is crucial for the steady of hemodynamie and tissue oxygen consumption, but excessive fluid administration is deleterious in critically ill patients, particularly in case of sepsis and/or lung injury. Thus assessment of volume responsiveness before deciding to administer volume expansion is of great importance, for the purpose of avoiding blind fluid administration. Through reviewing all the indicators and clinical reports about volume responsiveness, static hemodynamic parameters, such as central venous pressure and pulmonary capillary wedge pressure, which have been used for many years, lose their predictive value because of some limitations. And functional hemodynamic monitoring indexes, such as pulse pressure variation and stroke volume variation, which are based on the heart lung interactions, cannot be used in cases of spontaneous breathing activity, cardiac arrhythmias, low tidal volume or low lung compliance. Thus the end-expiratory occlusion, ＂mini＂ fluid challenge, and the passive leg-raising test can be used as alternative methods,solving the problem of prediction of volume responsiveness in cases of spontaneous breathing activity and/or cardiac arrhythmias, but the dependability and limitation are in the further research.

关 键 词：机械通气 容量反应性 呼气末屏气试验 微量静脉输液 被动抬腿试验 

分 类 号：R472.9[医药卫生—护理学]