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Advanced Patient Monitoring

个性化围术期输液管理

 

为什么我们注重个性化监测手段

每个患者本就不同,监测需求也会因患者而异。因此,应采用定制的术中输液管理方法来控制、跟踪和观察各种手术患者的血液动力情况。[1]

如今在合并症增加的老龄化人群中,血液动力监测对于优化围手术期输液管理尤为重要。[1] 麻醉诱导,手术和术后密切监测血流动力已经被证实可以防止术后不良反应。[2]

通过血流监测做好输液管理

从血压、血流量,容量反应性,全身血管阻力到心脏收缩力:先进的血液动力学监测可开发用于容量、正性肌力和血管活性药物管理的治疗策略,以优化组织灌注。[1],[3]

研究表明:
通过术中输液管理改善预后

大量研究表明,术中使用个体化目标导向的输液治疗可改善手术后的效果,并可以节省医院的成本。[2],[4],[5] 此外,《术后增强恢复》(ERAS)草案建议采用通过血流动力学监测来优化个体化的术中输液。[6]

Perioperative fluid management lowered risks of comoplicaitons

高风险和中风险的手术患者如果缺乏围术期管理,不仅可能引起心血管并发症,而且还增加神经系统并发症、肾脏损害甚至死亡的风险。[1],[2],[3]

 

然而,即使是对健康患者进行基本干预,也存在发生并发症的风险,例如低血压。血压是患者重要的生命体征之一,也应持续监测以便了解患者的病情。[7],[8]

 

早期发现围术期低血压的重要性

术中低血压是如何产生的,这个问题很难达成共识,但研究清楚地表明,保持术中平均动脉压(MAP)大于 65mmHg 可以降低并发症和不良反应的风险。[9]

此外,研究表明,将降压血压波动限制在基线的 30% 以下有助于预防术后中风。[10] 在手术室中连续不断地进行血压监测是安全管理血液动力状况的一种方法。

连续血压测量所带来的益处

我们在先进血液动力监测方面的创新技术可在手术过程中提供连续且无创的参数。  NICCI 为术中低血压监测以及进一步的血液动力变量(如血流量,预负荷和收缩力参数)的评估提供了易于使用且舒适的解决方案。

进一步了解无创血液动力监测

保持患者输液状态平衡

进行高危和中危手术的患者总会保持密切警惕。[2] 卓越的围术期输液管理是成功康复的关键。[2],[11] 借助动态范围的血液动力参数,您可以成功地为患者优化卓越的个性化治疗方法。[12] 通过动态参数指导输液疗法,以优化氧气输送和氧气消耗之间的平衡。

 

进一步了解 ProAQT 提供的主要参数

Getinge CeVOX

保持足够的氧气平衡

患者的重要器官会对缺氧发作高度敏感。我们提供用于连续氧平衡监测的解决方案,它易于使用,可帮助您了解患者的氧代谢情况。

进一步了解 CeVOX 监测

持续识别患者的风险水平

通过对血流动力参数的概览,以及阈值之间的相互作用,可以及时、有针对性地调整治疗方案。不断更新患者血流动力状况的变化情况,有助于调整针对每个患者的治疗策略。

了解 PulsioFlex 监测平台

所有参考

  1. Yamada T, Vacas S, Gricourt Y, Cannesson M.
    Improving Perioperative Outcomes Through Minimally Invasive and Non-invasive
    Hemodynamic Monitoring Techniques. 2018:Front. Med. 5:144.
    doi: 10.3389/fmed.2018.00144

  2. 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.

  3. Giglio M, Marucci M, Testini M, Brienza N.
    Goal-directed haemodynamic therapy and gastrointestinal
    complications in major surgery: a meta-analysis of randomized controlled trials
    British Journal of Anaesthesia 103(5):637–46 (2009)
    doi:10.1093/bja/aep279

  4. Cecconi M, Fasano N, Langiano N, Divella M, Costa M, Rhodes A, Rocca G.
    Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia. Critical Care 2011, 15:R132.

  5. Michard F, et al.
    Potential return on investment for implementation of perioperative goal-directed fluid therapy in major surgery: a nationwide database study. Perioper Med 2015;4(11).

  6. Mythen MG, Swart M, Acheson N, et al.
    Perioperative fluid management: consensus statement from the Enhanced
    Recovery Partnership. Perioper Med. 2012, 1:2. doi: 10.1186/2047-0525-1-2

  7. Benes J, Haidingerova L, Pouska J et al.
    Fluid management guided by a continuous non-invasive arterial pressure device is associated with decreased postoperative morbidity after total knee and hip replacement. BMC Anesthesiol. 2015;15(1).

  8. Stenglova A, Benes J,
    Continuous Non-Invasive Arterial Pressure Assessment during Surgery to Improve Outcome. Front Med (Lausanne). 2017 Nov 17;4:202

  9. Salmasi V, Maheshwari K, Yang D, et al.
    Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis. Anesthesiology 2017;126(1):47-65. https://doi.org/10.1097/ALN.0000000000001432

  10. Bijker J, Persoon S, Linda M. et al.
    Intraoperative Hypotension and Perioperative Ischemic Stroke after General Surgery: A Nested Case-control Study. Anesthesiology 2012;116(3):658-664. https://doi.org/10.1097/ALN.0b013e3182472320

  11. Bellamy MC.
    Wet, dry or something else?
    Br J Anaesth. 2006;97(6):755-757. doi:10.1093/bja/ael290

  12. Benes J, Giglio M, Brienza N, Michard F.
    The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized
    Controlled trials. Critical Care. 2014;18(5).