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Covid 19 - Resource center

GDT

目标导向治疗

可以标准化治疗吗?

1988年,Shoemaker制定了目标导向治疗的最初原则,并报告了其在治疗效果上的优势。[1]

自那以后这个概念就被采用了,新的围手术期适应症如全身、腹部、心脏和骨科手术都有了发展。通过GDT能改善治疗效果已在许多文献中得到证实。

在世界各地的医生和护士的日常工作中,流程或标准操作程序变得为越来越重要。它们是将GDT概念转化为临床实践的关键工具。

腹部外科手术中的GDT:Salzwedel研究

将心指数(CI)、脉压变异度(PPV)和平均动脉压(MAP)作为智能流程的靶参数,Salzwedel等能显著减少并发症。标准的桡动脉,高分辨率的压力传感器(ProAQT),,监测系统(PulsioFlex)和管理病人的计划(流程)是成功的精髓。

Read more about the outcome results

GDT在心脏手术中的应用:Goepfert研究

Goepfert等仅以全心舒张末容积指数(GEDI)、每搏量变异度(SVV)、平均动脉压(MAP)和心率(HR)为目标参数,结合智能流程,就能显著降低心脏手术患者ICU的并发症和缩短住院时间。经肺热稀释导管(PiCCO),标准压力传感器,监测系统(PulsioFlex)和管理病人的计划是成功的精髓。

Read more about the outcome results

所有参考

  1. Shoemaker WC et al., Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988; 94(6): 1176-86.

  2. Goepfert M et al., Individually Optimised Haemodynamic Therapy Reduces Complications and Length of Stay in the Intensive Care Unit - A Prospective, Randomised Controlled Trial. Anesthesiology 2013; 119(4): 824-836.

  3. Salzwedel C et al., Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Crit Care 2013; 17(5): R191.