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合併症が増加する高齢患者では、周術期の輸液管理を最適化する血行動態モニタリングの重要性はさらに高まっています。[1] 麻酔導入時、術中、術後の血行動態を綿密にモニタリングすることが有害事象発生を予防することが報告されています。[2]


術中の患者に合わせた目標指向型輸液療法は術後の転帰を改善し、病院にとっての費用対効果にも有益であることが多くの研究で実証されています。[2][4][5] さらに、術後早期回復(ERAS)プロトコルでは、血行動態モニタリングで術中の輸液を個別に最適化することを推奨しています。[6]

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  1. 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. 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. 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. 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. 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. 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. 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 nesthesiol. 2015;15(1).

  8. 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. 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.

  10. 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.

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

  12. 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).


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