非标准状态下脉压变异率评估患者容量反应性的研究进展  

Research progress in the assessment of volume responsiveness of patients with pluse pressure variation in non-standard states

作　　者：吴秋荣 王彬[1] WU Qiurong;WANG Bin(Department of Anesthesiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院麻醉科,400016

出　　处：《临床麻醉学杂志》2024年第3期300-303,共4页Journal of Clinical Anesthesiology

基　　金：重庆市科委面上项目(CSTB2022NSCQ-MSX0061)。

摘　　要：容量反应性是目标导向液体治疗(GDFT)的核心,脉压变异率(PPV)反映每搏输出量随呼吸的变化,能够准确评估患者的容量反应性。然而,PPV监测依赖于心肺相互作用,测量时有严格的条件限制。PPV测量的标准状态要求患者接受机械通气,潮气量至少为预测体重(PBW)8 ml/kg,同时不合并自主呼吸、低肺顺应性、心律失常、胸腔开放、腹内高压和高呼吸频率等,不完全满足上述测量条件时测得的PPV则为非标准状态下PPV。临床上多数患者不满足PPV测量的标准状态,因此如何保证非标准状态下PPV应用的有效性成为当前临床研究的热点。本文综述了PPV的原理以及非标准状态下PPV的临床应用等内容,为临床合理使用PPV监测提供参考。Volume responsiveness is the core of goal-directed fluid therapy(GDFT),and pulse pressure variation(PPV)reflect changes in stroke volume with breathing,enabling accurate assessment of a patient s volume responsiveness.However,PPV monitoring relies on cardiopulmonary interactions,which are subject to strict conditions.The standard condition of PPV measurement requires the patient to receive mechanical ventilation with a tidal volume not less than 8 ml/kg of predicted body weight(PBW),without spontaneous breathing,low lung compliance,arrhythmia,open chest,intra-abdominal hypertension,or high respiratory rate.When the above conditions could not be fully met,the measured PPV was defined as the PPV in non-standard states.Most clinical scenarios do not meet the standard state of PPV,so how to ensure the effectiveness of PPV in non-standard states has become a hot topic in clinical research.This article reviews the principle of PPV and the clinical application of PPV in non-standard conditions,to provide a reference for clinical rational use of PPV.

关 键 词：容量反应性 脉压变异率 非标准状态 目标导向液体治疗 

分 类 号：R614[医药卫生—麻醉学]