每搏量变异度指导围术期目标导向性液体治疗的Meta分析
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摘要
目的：液体治疗(fluid therapy)的目标是维持机体的有效循环血容量,从而保证组织、器官所需氧供,维持机体水、电解质和酸碱代谢的平衡,对抗手术创伤可能引起的身体损害,以及作为围术期过程中大多数临床治疗给予药物的载体。围术期液体治疗既要避免输液不足可能导致的隐匿性低血容量和组织低灌注,也要杜绝输液过多可能导致的心功能不全和外周组织水肿。对于液体治疗的相关研究,数十年来对于“干湿之争”、“晶胶之争”的讨论各据己见互不相让,至今仍然未有定论,近些年来,目标导向性液体治疗(Goal-directed fluid therapy)的观点被提出并且逐渐引起麻醉科医生和临床医生的重视,所谓目标导向性液体治疗,是指根据不同患者在麻醉或手术过程中循环功能状况的随时变化而实施相应随之变化的液体治疗策略,与“限制性输液”的液体治疗策略相比,能够获得更佳的循环功能、组织灌注和氧合指标而不增加输液总量,从而保证患者围术期生命体征平稳,减少术后并发症。然而如何才能获得最优化的液体治疗,“目标导向性液体治疗”的“目标”又该如何界定、以何种可以方便测得的量化指标来反映,都是目前没有明确的标准仍需要进一步探究所证实的。每搏量变异度(stroke volume variation, SVV)是应用于液体管理的一种动态参数,其基于在全身麻醉条件下完全机械通气控制呼吸的患者心和肺的交互作用,其指导液体治疗的价值优于传统应用较多的静态指数(如CVP、PCWP等)已被多项临床研究证实。在机械通气控制呼吸的条件下,每搏量变异度(stroke volume variation,SVV)是计算一个呼吸循环的最大的每搏量(SVmax)与最小的每搏量(SVmin)的差值与每搏量平均值(SVmean)的比值,可以预测其与Frank-Starling曲线的关系及心脏对容量负荷的反应。每搏量变异度(stroke volume variation, SVV)被认为是容量反应性的良好预测指标,在预测机体对补液的反应性方面敏感性和特异性较高,近年来SVV作为指导围术期体液治疗的较敏感指标已被应用于临床实践,但仍然受到一些因素的限制。本文旨在分析每搏量变异度(stroke volume variation, SVV)在围术期液体治疗中的指导价值,为围术期目标导向性最优化液体治疗的实施寻找准确易行的指标。
方法:Meta分析是系统评价(systematic review, SR)中常用的一种统计方法,具有很高的“效价比”。本文选取相应的临床研究资料,通过检索Medline数据库中的相关文献,以stroke volume variation (SVV)、fluid therapy为主要检索词进行检索2000年至今的文献,一共检索到74篇相关文献,经过阅读文献全文或摘要,研究评价动态容量性指标SVV在预测液体反应性方面的价值的临床研究被纳入,动物实验性研究、综述类文献、自主呼吸患者的病例临床研究、无法得到相关数据的文献等被剔除,并对纳入最终分析的文献所引用的文献全文或摘要逐一进行阅读,并判断是否增加最终纳入meta分析的文献总量。然后对最终筛选所纳入的临床研究及其结果进行meta分析,来评价每搏量变异度(stroke volume variation, SVV)指导围术期液体治疗准确性的价值。
结果：共有11篇文献中420名患者入选本文的meta分析,所有入选文献均为研究评价动态容量性指标每搏量变异度(stroke volume variation, SVV)在预测液体反应性方面的价值的临床研究,病例来源包括手术室和重症监护室,入选最终分析的患者均为机械控制呼吸且潮气量为8-10ml/kg。对最终纳入文献阅读分析之后,提取所纳入文献的相关数据信息,主要包括研究设计、样本含量、研究方案设置、入选研究的患者人数、入选研究中血流动力学监测方法、液体治疗所应用的液体种类、液体反应性阳性的界定标准、相关系数(correlation coefficient)、SVV预测液体反应性的阈值及其灵敏性和特异性,以及SVV预测液体反应性的受试者工作特征曲线下面积(AUC-ROC, receiver-operating characteristic curve)及95%置信区间(confidence interval, CI)等。通过对最终入选文献及其数据的meta分析,SVV基线值与液体反应性显著相关,其合并的相关系数值为0.718。经过统计分析得到每搏量变异度(stroke volume variation, SVV)作为预测液体反应性的指标敏感度为82.3%(95%CI为0.773-0.866),特异度为85%(95%CI为0.796-0.895),阳性似然比为5.245(95%CI为3.827-7.188),阴性似然比为0.21(95%CI为0.161-0.273),其诊断比数比为26.291(95%CI为16.057-43.048),SVV预测液体反应性的受试者工作特征曲线下面积AUC为0.9052。通过PiCCO或者Flotrac/Vigileo系统监测而得到的每搏量变异度(stroke volume variation, SW)对手术室或者重症监护室的患者的液体反应性具有诊断性预测价值。
结论：每搏量变异度(SW)可以作为评价液体反应性的敏感指标,指导围术期液体治疗以达到液体治疗的最优化。
Purpose:The main purpose of fluid therapy is to maintain the body effective circulating blood volume, guarantee necessary oxygen for organization and organs, maintain the balance of water, electrolyte and acid-base metabolism of the body, against the body damage that may caused by surgical trauma, as well as being most of the carrier in the process of perioperative period should both to avoid concealed hypovolemia and low infusion caused by the lack of intravascular infusion, and also avoid cardiac insufficiency and peripheral tissue edema that may caused by Infusion too much. Perioperative fluid therapy is the subject of much controversy, the debate of "restricted intravenous fluid therapy" and "standard fluid therapy", and the debate of using crystal or colloid have been inconclusive for decades, each group according to his own opinion to outdo each other. In recent years, goal-directed fluid therapy has gradually caused the attention of anesthesia doctors and clinicians, the so-called goal-directed fluid therapy is the process of implementing real-time fluid treatment is based on the real-time circulation function status of each patient under anesthesia or surgery. Compared with restricted intravenous fluid therapy, the goal-directed fluid therapy neither increase the infusion amount, and can obtain better circulation function, tissue perfusion and oxygenation index. However, how to obtain the optimal perioperative fluid therapy in order to make sure patients vital signs stable during perioperative period and reduce postoperative complications, and how to define the "goal" of the "goal-directed fluid therapy", in what quantitative indicators that can be measured to reflect,are all of no clear standards currently and still need further study. Stroke volume variation (SVV) is a kind of dynamic parameters of fluid management, SVV is based on the interaction of the heart and lungs of the patients who were mechanical ventilationed under general anesthesia, and several studies have confirmed the value of SVV guide fluid therapy is superior to the traditional static index (e.g., CVP, PCWP, etc.). Under the condition of mechanical ventilation controls breathing, SW is to calculate the the difference between the maximum number of every stroke of a respiratory cycle (SVmax) and the minimum amount of stroke (SVmin), and then calculate the ratio between that difference and average value of stroke volume (SVmean), SVV can predict heart response capacity to the volume load and the relationship with Frank-Starling curve that reflected cardiac function. SW is considered to be a good predictor of reactive capacity, and has high sensitivity and specificity in the prediction of rehydration reaction, SVV has been applied in varies of clinical practices as an important approach to guide fluid therapy during perioperative fluid management in recent years, but there are still some factors restricting its application in the clinical practice in the daily work. The purpose of this paper is to analyze the value of using stroke volume variation to guide perioperative fluid therapy, and to find a accurate and feasible goal for goal directed and optimizing fluid therapy during perioperative period.
Methods:Meta analysis is a commonly used statistical method in the systematic review (SR), and has the very high potency ratio. This article selects the corresponding clinical data, retrieve relevant literature in the Medline database, using SVV, fluid therapy for primary retrieval word, this paper retrieved the literatures from2000to the present, the research got74related papers, through reading the full text or abstract in depth, those clinical research which study and evaluate the value of the dynamic capacity indicator SVV in predicting fluid responsiveness were included in the final meta analysis. Animal experimental research, the literature of review, cases of spontaneous breathing in patients in the clinical research, and the literature cannot get the relevant data have been dropped, and the referenced documents of those literatures included in the final meta analysis were read one by one to judge whether to increase the final included literature amount. And then conducted meta analysis with the final included clinical researchs, and to discuss the value of accuracy of SVV guiding fluid treatment.
Results:A total of420patients from11studies were included in the final meta analysis of this article, all the literatures included in are those clinical researches which study and evaluate the value of the dynamic capacity indicator stroke volume variation (SVV) in predicting fluid responsiveness.The case sources including the operating room (OR) and Intensive Care Unit (ICU), all the patients included were in mechanical control breathing and the tidal volume were8-10ml/kg. After the quality evaluation of the included literature, then extract related data information from the literature, mainly including research design, sample size, setting of research plan, the number of patients included in the study, hemodynamic detection method, liquid type during the fluid therapy, definition standard of fluid load positive, the correlation coefficient, threshold of SVV predicting fluid responsiveness and its sensitivity and specificity, and the receiver operating characteristic curve (AUC) for SVV in predicting fluid responsiveness, and the95%confidence interval(CI), etc. Baseline SVV was correlated to fluid responsiveness with a pooled correlation coefficient of0.718. Across all settings, we found a diagnostic odds ratio of26.291(95%CI16.057-43.048) for SVV to predict fluid responsiveness at a sensitivity of82.3%(95%CI0.773-0.866) and specificity of85%(95%CI0.796-0.895), the positive likelihood ratio of5.245(95%CI3.827-7.188),the negative likelihood ratio of0.21(95%CI0.161-0.273), and the receiver operating characteristic curve (AUC) for SVV was0.9052. The SVV was of diagnostic value for fluid responsiveness in operating room (OR) or Intensive Care Unit (ICU) patients monitored with the PiCCO or the FloTrac/Vigileo system.
Conclusion:Stroke volume variation (SVV) can be a sensitive indicator to evaluate fluid responsiveness, and can be guide perioperative fluid management to reach the fluid therapy optimization.
方法:Meta分析是系统评价(systematic review, SR)中常用的一种统计方法,具有很高的“效价比”。本文选取相应的临床研究资料,通过检索Medline数据库中的相关文献,以stroke volume variation (SVV)、fluid therapy为主要检索词进行检索2000年至今的文献,一共检索到74篇相关文献,经过阅读文献全文或摘要,研究评价动态容量性指标SVV在预测液体反应性方面的价值的临床研究被纳入,动物实验性研究、综述类文献、自主呼吸患者的病例临床研究、无法得到相关数据的文献等被剔除,并对纳入最终分析的文献所引用的文献全文或摘要逐一进行阅读,并判断是否增加最终纳入meta分析的文献总量。然后对最终筛选所纳入的临床研究及其结果进行meta分析,来评价每搏量变异度(stroke volume variation, SVV)指导围术期液体治疗准确性的价值。
结果：共有11篇文献中420名患者入选本文的meta分析,所有入选文献均为研究评价动态容量性指标每搏量变异度(stroke volume variation, SVV)在预测液体反应性方面的价值的临床研究,病例来源包括手术室和重症监护室,入选最终分析的患者均为机械控制呼吸且潮气量为8-10ml/kg。对最终纳入文献阅读分析之后,提取所纳入文献的相关数据信息,主要包括研究设计、样本含量、研究方案设置、入选研究的患者人数、入选研究中血流动力学监测方法、液体治疗所应用的液体种类、液体反应性阳性的界定标准、相关系数(correlation coefficient)、SVV预测液体反应性的阈值及其灵敏性和特异性,以及SVV预测液体反应性的受试者工作特征曲线下面积(AUC-ROC, receiver-operating characteristic curve)及95%置信区间(confidence interval, CI)等。通过对最终入选文献及其数据的meta分析,SVV基线值与液体反应性显著相关,其合并的相关系数值为0.718。经过统计分析得到每搏量变异度(stroke volume variation, SVV)作为预测液体反应性的指标敏感度为82.3%(95%CI为0.773-0.866),特异度为85%(95%CI为0.796-0.895),阳性似然比为5.245(95%CI为3.827-7.188),阴性似然比为0.21(95%CI为0.161-0.273),其诊断比数比为26.291(95%CI为16.057-43.048),SVV预测液体反应性的受试者工作特征曲线下面积AUC为0.9052。通过PiCCO或者Flotrac/Vigileo系统监测而得到的每搏量变异度(stroke volume variation, SW)对手术室或者重症监护室的患者的液体反应性具有诊断性预测价值。
结论：每搏量变异度(SW)可以作为评价液体反应性的敏感指标,指导围术期液体治疗以达到液体治疗的最优化。
Purpose:The main purpose of fluid therapy is to maintain the body effective circulating blood volume, guarantee necessary oxygen for organization and organs, maintain the balance of water, electrolyte and acid-base metabolism of the body, against the body damage that may caused by surgical trauma, as well as being most of the carrier in the process of perioperative period should both to avoid concealed hypovolemia and low infusion caused by the lack of intravascular infusion, and also avoid cardiac insufficiency and peripheral tissue edema that may caused by Infusion too much. Perioperative fluid therapy is the subject of much controversy, the debate of "restricted intravenous fluid therapy" and "standard fluid therapy", and the debate of using crystal or colloid have been inconclusive for decades, each group according to his own opinion to outdo each other. In recent years, goal-directed fluid therapy has gradually caused the attention of anesthesia doctors and clinicians, the so-called goal-directed fluid therapy is the process of implementing real-time fluid treatment is based on the real-time circulation function status of each patient under anesthesia or surgery. Compared with restricted intravenous fluid therapy, the goal-directed fluid therapy neither increase the infusion amount, and can obtain better circulation function, tissue perfusion and oxygenation index. However, how to obtain the optimal perioperative fluid therapy in order to make sure patients vital signs stable during perioperative period and reduce postoperative complications, and how to define the "goal" of the "goal-directed fluid therapy", in what quantitative indicators that can be measured to reflect,are all of no clear standards currently and still need further study. Stroke volume variation (SVV) is a kind of dynamic parameters of fluid management, SVV is based on the interaction of the heart and lungs of the patients who were mechanical ventilationed under general anesthesia, and several studies have confirmed the value of SVV guide fluid therapy is superior to the traditional static index (e.g., CVP, PCWP, etc.). Under the condition of mechanical ventilation controls breathing, SW is to calculate the the difference between the maximum number of every stroke of a respiratory cycle (SVmax) and the minimum amount of stroke (SVmin), and then calculate the ratio between that difference and average value of stroke volume (SVmean), SVV can predict heart response capacity to the volume load and the relationship with Frank-Starling curve that reflected cardiac function. SW is considered to be a good predictor of reactive capacity, and has high sensitivity and specificity in the prediction of rehydration reaction, SVV has been applied in varies of clinical practices as an important approach to guide fluid therapy during perioperative fluid management in recent years, but there are still some factors restricting its application in the clinical practice in the daily work. The purpose of this paper is to analyze the value of using stroke volume variation to guide perioperative fluid therapy, and to find a accurate and feasible goal for goal directed and optimizing fluid therapy during perioperative period.
Methods:Meta analysis is a commonly used statistical method in the systematic review (SR), and has the very high potency ratio. This article selects the corresponding clinical data, retrieve relevant literature in the Medline database, using SVV, fluid therapy for primary retrieval word, this paper retrieved the literatures from2000to the present, the research got74related papers, through reading the full text or abstract in depth, those clinical research which study and evaluate the value of the dynamic capacity indicator SVV in predicting fluid responsiveness were included in the final meta analysis. Animal experimental research, the literature of review, cases of spontaneous breathing in patients in the clinical research, and the literature cannot get the relevant data have been dropped, and the referenced documents of those literatures included in the final meta analysis were read one by one to judge whether to increase the final included literature amount. And then conducted meta analysis with the final included clinical researchs, and to discuss the value of accuracy of SVV guiding fluid treatment.
Results:A total of420patients from11studies were included in the final meta analysis of this article, all the literatures included in are those clinical researches which study and evaluate the value of the dynamic capacity indicator stroke volume variation (SVV) in predicting fluid responsiveness.The case sources including the operating room (OR) and Intensive Care Unit (ICU), all the patients included were in mechanical control breathing and the tidal volume were8-10ml/kg. After the quality evaluation of the included literature, then extract related data information from the literature, mainly including research design, sample size, setting of research plan, the number of patients included in the study, hemodynamic detection method, liquid type during the fluid therapy, definition standard of fluid load positive, the correlation coefficient, threshold of SVV predicting fluid responsiveness and its sensitivity and specificity, and the receiver operating characteristic curve (AUC) for SVV in predicting fluid responsiveness, and the95%confidence interval(CI), etc. Baseline SVV was correlated to fluid responsiveness with a pooled correlation coefficient of0.718. Across all settings, we found a diagnostic odds ratio of26.291(95%CI16.057-43.048) for SVV to predict fluid responsiveness at a sensitivity of82.3%(95%CI0.773-0.866) and specificity of85%(95%CI0.796-0.895), the positive likelihood ratio of5.245(95%CI3.827-7.188),the negative likelihood ratio of0.21(95%CI0.161-0.273), and the receiver operating characteristic curve (AUC) for SVV was0.9052. The SVV was of diagnostic value for fluid responsiveness in operating room (OR) or Intensive Care Unit (ICU) patients monitored with the PiCCO or the FloTrac/Vigileo system.
Conclusion:Stroke volume variation (SVV) can be a sensitive indicator to evaluate fluid responsiveness, and can be guide perioperative fluid management to reach the fluid therapy optimization.
引文
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[33]Zhang HM, Liu DW, Wang XT, et al. Stroke volume variation in the evaluation of fluid responsiveness in refractory septic shock. Zhonghua Nei Ke Za Zhi,2010, 49:610-613.
[34]Kirov MY, Kuzkov VV, Molnar Z, Perioperative haemodynamic therapy[J]. Curr Opin Crit Care,2010,16(4):384-392.
[35]Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med,2002,345(19):1368-1377.
[36]Kern JW, Shoemaker WC. Meta-analysis of hemodynamie optimization in high-risk patients. Crit Care Med,2002,30(8):1686-1692.
[37]杜园园,于布为。围手术期液体动力学的研究进展。中国危重病急救医学,2008,20(7)：441-445.
[38]Mitchell JP, Schuller D, Calandrino FS, et al. Improved outcome based on fluid management in critically ill patients reqnirirlg pulmonary artery catheterization. Am Rev Respir Dis,1992,145:990-998.
[39]Hudson E, Beale RGN. Lung water and blood volume measurements in the critically ill[J]. Curt Option Crit Care,2000,6:222-226.
[40]Solus Biguenet H, Fleyfel M, Tavernier B, et al. Non·invasive prediction of fluid responsiveness during major hepatic surgery. Br J Anaesth,2006,97(6):808—816.
[41]Tavernier B, Makhatine O, Lebuffe G, et al. Systolic pressure variation as aguide to fluid therapy in patients with sepsis--induced hypotension. Anesthesiology,1998, 89(6):1313—1321.
[42]Kumar, Ariel R, Bunne E, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance or the response to volume infusion in normal subjects. Crit Care Med,2004,32:691—699.
[43]Pinsky MR, Payen D. Functional hemodynamic momtofing. Crit Care,2005, 9(6):566—572.
[44]Cavallaw F, Sandreni C, Antonelli M. Functional hemodynamic monitofing and dynamic indices of fluid responsiveness. Minerva Anestesial,2008,74(4):123—135.
[45]Biais M, Bernard O, Ha JC, et al. Abilities of pulse pressure vaciations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery. Br J Anaesth,2010,104(4):407-413.
[46]Renner J, Cavus E, Meybohm P, et al. Stroke volume vailation during hemorrhage and after fluid loading:impact of different tidal volumes. Acta Anaesthesiol Scand,2007,51(5):538-544.
[47]Versprille A,Jansen JR,Ffietman RC,et al. Negative effect of insufflation on cardiac output and pulmonary blood volume. Acta Anaesthesiol Scand,1990,34(8): 607-615.
[48]Szold A, Pizov R, Segal E, eI al. The effect of tidal volume and intravascular volume state on systolic pressure variation in ventilated dogs. Intermive Care Med, 1989,15(6):368-371.
[49]Reuter DA, Bayedein J, Goefert MS, et al. Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients. Intensive Care Med,2003,29(3):476-480.
[50]De Backer D, Taccone FS, Holsten R, et al. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology,2009, 110(5):1092-1097.
[51]Reuter DA, Goepfert MS, Goresch T, et al. Assessing fluid responsiveness during open chest conditions. Br J Anaesth,2005,94(3):318-323.
[52]Christoph KH, Alban S, Luc W, et al. Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac(tm) and PiCCO plus system. Critical Care,2008,12:82-83.
[53]Cannesson M, Attof Y, Rosamel P. Comparison of FloTrac cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements[J]. Eur J Anaesthesiol,2007, 24(10):832-839.
[54]Breukers RM, Sepehrkhouy S, Spiegelenberg SR, Cardiac output measured by a new arterial pressure waveform analysis method without calibration compared with thermodilution after cardiac surgery[J]. J Cardiothorac Vase Anesth,2007,21(5): 632-635.
[55]Manecke GR Jr, Auger WR. Cardiac output determination from the arterial pressure wave:clinical testing of a novel algorithm that does not require calibration[J]. J Cardiothorac Vase Anesth,2007,21(1):3-7
[56]Biancofiore G, Critchley LA, Lee A, Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery[J]. Br J Anaesth,2009,102(1):47-54.
[57]Bundgaard-Nielsen M, Holte K, Secher NH, et al. Monitoring of perioperative fluid administration by individualized goal-directed therapy. Acta Anaesthesiol Scand, 2007,51(3):331-340.
[1]Loepke AW, Spaeth JP. Glucose and heart surgery:neonates are not just small adults[J]. Anesthesiology,2004,100(6):1339,1341.
[2]Orlinsky M, Shoemaker W, Reis ED. Current controversies in shock and resuscitation[J]. Surg Clin North Am,2001,81 (6):1217-1262
[3]Waikar SS, Chertow GM, Crystalloids versus colloids for resuscitation in shock[J]. Current Opinion in Nephrology and Hypertension,2000,9(5):501-504
[4]Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery[J]. Anesth analg,2001,93(2): 405-409
[5]Moretti EW, Robertson KM, El Moalen H,et al.Intraoperative collid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration[J].Anasth Analg,2003,96(2):611-617
[6]Sehierhout G, Robertal. Fluid resuscitation with colloid or crystalloid Solutions in critically ill patients:a systematic review of randomized trials[J].BMJ,1998,16(7136): 961-964
[7]Choi PT, Yip G, Quinonez LG, et al. Crystalloids vs colloids in fluid resuscitation:a systematic review[J]. Crit Care Med,1999,27(1):200-210
[8]Rioux JP, Lessard M, De Bortoli B, et al. Pentastarch 10%(250kDa/0.45) is an independent risk factor of acute kidney injury following cardiac surgery[J]. Crit Care Med,2009,37(4):1293-1298
[9]Moretti EW, Robertson KM,E1 Moalem H,et al.Intraoperative collid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration[J]. Anasth Analg,2003,96 (2):611
[10]岳云,姚尚龙,黄文起,叶铁虎,吴新民。围术期输血指南(2007)。
[11]Chappell D, Hofmann KK, Conzen P, et al. A rational approach to perioperative fluid management [J]. Anesthesiology,2008,109(4):723-740.
[12]Brandstrup B,Tonnesen H,Beier holgersen R,et al.Effects of intravenous fluid restriction on postoperative complications:comparison of two perioperative fluid regimens:a randomized as-sessor blinded multicenter trial[J].Ann Surg,2003,238 (5):641-648.
[13]Wenkui Y, Ning L, Jianfeng G, et al.Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malig-nancy[J]. Surgery,2010,147(4):542-552
[14]Concha MR, Mertz VF, Cortinez LI, et al. The volume of lactated Ringer's solution required to maintain preload and cardiac index during open and laparoscopic surgery[J]. Anesth Analg,2009,108(2):616-622
[15]Kimber O, Arnberger M, Brandt S, et al. Goal-directed colloid administration improves the microcirculation of healthy and perianastomotic colon[J]. Anesthesiology,2009,110(3):496-504
[16]Bundgaard NM, Ruhnau B, Secher NH, et al. Flow related techniques for preoperative goal directed fluid optimization[J]. Br J Anaesth,2007,98 (1):38-44.
[17]Soni N. British consensus guidelines on intravenous fluid therapy for adult Surgical patients (GIFTASUP):cassandra's view[J].Anaesthesia,2009,64(3):235-238.
[18]Shoemaker WC, Printen KJ, Amato JJ, et al. Hemodynamic patterng after acute anesthetized and unanesthetized trauma. Evaluation of the consequence of changes in cardiac output and derived calculations. Arch Surg,1967,95(3):492-499.
[19]Shoemaker WC, Montgomery ES, Kaplan E, et al. Physiologic patterns in surviving and nonsurviving shock patients. Use of sequential cardiorespiratory variables in defining criteria for therapeutic goals and early warning of death. Arch Surg,1973,106(5):630-636.
[20]Gattinoni L, Braszi L, Pelosi P, et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. Sv02 Collaborative Gronp. N Engl J Med,1995, 333(16):1025-1032.
[21]Rivers E,Nguyen B,Havstad S, et al. Early coal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med,2001,345(19):1368-1377.
[22]Hollenberg BM, Ahrens TS, Annane G, et al. Practice parameters for hemodynamic support of sepsis in adult patients:2004 update. Critical Care Medicine, 2004, (22):1928-1948
[23]Kumar, Ariel R, Bunne JE, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance or the response to volume infusion in normal subjects. Crit Care Med,2004, (32):691—699.
[24]Shah MR, Easselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients:meta analysis of randomized clinical trials JAMA, 2005,294(13):1664-1670.
[25]Wenkui Y, Ning L, Jianfeng G, et al.Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malig-nancy[J]. Surgery,2010,147(4):542-552
[26]陈强,赖西南,葛衡江。低血容量性休克复苏的新认识[J]。中国急救医学,2005,25(3)：201-203
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[29]Cavallaw F, Sandreni C, Antonelli M, Functional hemodynamic monitofing and dynamic indices of fluid responsiveness. Minerva Anestesial,2008,74(4):123—135.
[30]Lopes MR, Oliveira MA, Pereira VO, et al. Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery:a pilot randomized controlled trial. Crit Care,2007,11(5):100
[31]Cannesson M,Attof Y,Rosamel P.Comparison of FloTrac cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements[J]. Eur J Anaesthesiol,2007, 24(10):832-839.
[32]Breukers RM, Sepehrkhouy S, Spiegelenberg SR. Cardiac output measured by a new arterial pressure waveform analysis method without calibration compared with thermodilution after cardiac surgery[J].Cardiothorac Vasc Anesth,2007,21(5): 632-635.
[33]Manecke GR Jr, Auger WR. Cardiac output determination from the arterial pressure wave:clinical testing of a novel algorithm that does not require calibration[J]. J Cardiothorac Vasc Anesth,2007,21(1):3-7
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[2]Kirov MY, Kuzkov VV, Molnar Z,Perioperative haemodynamic therapy [J]. Curr Opin Crit Care,2010,16(4):384-392.
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[21]BF Geerts, LPHJ Aarts, AB Groeneveld et al.Predicting cardiac output responses to passive leg raising by a PEEP-induced increase in central venous pressure, in cardiac surgery patients. British Journal of Anaesthesia,2011,107 (2):150-156.
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[26]M.Biais, K.Nouette-Gaulain, V.Cottenceau, P.Revel and F.Sztark. Uncalibrated pulse contour-derived stroke volume variation predicts fluid responsiveness in mechanically ventilated patients undergoing liver transplantation. British Journal of Anaesthesia,2008,101 (6):761-768.
[27]Khwannimit B, Bhurayanontachai R. Prediction of fluid responsiveness in septic shock patients:comparing stroke volume variation by FloTrac/Vigileo and automated pulse pressure variation. European Journal Of Anaesthesiology [Eur J Anaesthesiol], 2012,29 (2):64-69.
[28]Cecconi M, Monti G, Hamilton MA, et al. Efficacy of functional hemodynamic parameters in predicting fluid responsiveness with pulse power analysis in surgical patients. Minerva Anestesiologica [Minerva Anestesiol],2012,78 (5):527-533.
[29]Biais M, Bernard O, Ha JC, et al. Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery. Br J Anaesth,2010,104(4):407-413.
[30]Cannesson M, Musard H, Desebbe O, et al. The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients. Anesth Analg,2009,108(2):513-517.
[31]Hofer CK, Muller SM, Furrer L, et al. Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting. Chest,2005,128(2):848-854.
[32]Suehiro K, Okutani R. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing one-lung ventilation. J Cardiothorac Vasc Anesth,2010,24(5):772-775.
[33]Zhang HM, Liu DW, Wang XT, et al. Stroke volume variation in the evaluation of fluid responsiveness in refractory septic shock. Zhonghua Nei Ke Za Zhi,2010, 49:610-613.
[34]Kirov MY, Kuzkov VV, Molnar Z, Perioperative haemodynamic therapy[J]. Curr Opin Crit Care,2010,16(4):384-392.
[35]Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med,2002,345(19):1368-1377.
[36]Kern JW, Shoemaker WC. Meta-analysis of hemodynamie optimization in high-risk patients. Crit Care Med,2002,30(8):1686-1692.
[37]杜园园,于布为。围手术期液体动力学的研究进展。中国危重病急救医学,2008,20(7)：441-445.
[38]Mitchell JP, Schuller D, Calandrino FS, et al. Improved outcome based on fluid management in critically ill patients reqnirirlg pulmonary artery catheterization. Am Rev Respir Dis,1992,145:990-998.
[39]Hudson E, Beale RGN. Lung water and blood volume measurements in the critically ill[J]. Curt Option Crit Care,2000,6:222-226.
[40]Solus Biguenet H, Fleyfel M, Tavernier B, et al. Non·invasive prediction of fluid responsiveness during major hepatic surgery. Br J Anaesth,2006,97(6):808—816.
[41]Tavernier B, Makhatine O, Lebuffe G, et al. Systolic pressure variation as aguide to fluid therapy in patients with sepsis--induced hypotension. Anesthesiology,1998, 89(6):1313—1321.
[42]Kumar, Ariel R, Bunne E, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance or the response to volume infusion in normal subjects. Crit Care Med,2004,32:691—699.
[43]Pinsky MR, Payen D. Functional hemodynamic momtofing. Crit Care,2005, 9(6):566—572.
[44]Cavallaw F, Sandreni C, Antonelli M. Functional hemodynamic monitofing and dynamic indices of fluid responsiveness. Minerva Anestesial,2008,74(4):123—135.
[45]Biais M, Bernard O, Ha JC, et al. Abilities of pulse pressure vaciations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery. Br J Anaesth,2010,104(4):407-413.
[46]Renner J, Cavus E, Meybohm P, et al. Stroke volume vailation during hemorrhage and after fluid loading:impact of different tidal volumes. Acta Anaesthesiol Scand,2007,51(5):538-544.
[47]Versprille A,Jansen JR,Ffietman RC,et al. Negative effect of insufflation on cardiac output and pulmonary blood volume. Acta Anaesthesiol Scand,1990,34(8): 607-615.
[48]Szold A, Pizov R, Segal E, eI al. The effect of tidal volume and intravascular volume state on systolic pressure variation in ventilated dogs. Intermive Care Med, 1989,15(6):368-371.
[49]Reuter DA, Bayedein J, Goefert MS, et al. Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients. Intensive Care Med,2003,29(3):476-480.
[50]De Backer D, Taccone FS, Holsten R, et al. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology,2009, 110(5):1092-1097.
[51]Reuter DA, Goepfert MS, Goresch T, et al. Assessing fluid responsiveness during open chest conditions. Br J Anaesth,2005,94(3):318-323.
[52]Christoph KH, Alban S, Luc W, et al. Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac(tm) and PiCCO plus system. Critical Care,2008,12:82-83.
[53]Cannesson M, Attof Y, Rosamel P. Comparison of FloTrac cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements[J]. Eur J Anaesthesiol,2007, 24(10):832-839.
[54]Breukers RM, Sepehrkhouy S, Spiegelenberg SR, Cardiac output measured by a new arterial pressure waveform analysis method without calibration compared with thermodilution after cardiac surgery[J]. J Cardiothorac Vase Anesth,2007,21(5): 632-635.
[55]Manecke GR Jr, Auger WR. Cardiac output determination from the arterial pressure wave:clinical testing of a novel algorithm that does not require calibration[J]. J Cardiothorac Vase Anesth,2007,21(1):3-7
[56]Biancofiore G, Critchley LA, Lee A, Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery[J]. Br J Anaesth,2009,102(1):47-54.
[57]Bundgaard-Nielsen M, Holte K, Secher NH, et al. Monitoring of perioperative fluid administration by individualized goal-directed therapy. Acta Anaesthesiol Scand, 2007,51(3):331-340.
[1]Loepke AW, Spaeth JP. Glucose and heart surgery:neonates are not just small adults[J]. Anesthesiology,2004,100(6):1339,1341.
[2]Orlinsky M, Shoemaker W, Reis ED. Current controversies in shock and resuscitation[J]. Surg Clin North Am,2001,81 (6):1217-1262
[3]Waikar SS, Chertow GM, Crystalloids versus colloids for resuscitation in shock[J]. Current Opinion in Nephrology and Hypertension,2000,9(5):501-504
[4]Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery[J]. Anesth analg,2001,93(2): 405-409
[5]Moretti EW, Robertson KM, El Moalen H,et al.Intraoperative collid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration[J].Anasth Analg,2003,96(2):611-617
[6]Sehierhout G, Robertal. Fluid resuscitation with colloid or crystalloid Solutions in critically ill patients:a systematic review of randomized trials[J].BMJ,1998,16(7136): 961-964
[7]Choi PT, Yip G, Quinonez LG, et al. Crystalloids vs colloids in fluid resuscitation:a systematic review[J]. Crit Care Med,1999,27(1):200-210
[8]Rioux JP, Lessard M, De Bortoli B, et al. Pentastarch 10%(250kDa/0.45) is an independent risk factor of acute kidney injury following cardiac surgery[J]. Crit Care Med,2009,37(4):1293-1298
[9]Moretti EW, Robertson KM,E1 Moalem H,et al.Intraoperative collid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration[J]. Anasth Analg,2003,96 (2):611
[10]岳云,姚尚龙,黄文起,叶铁虎,吴新民。围术期输血指南(2007)。
[11]Chappell D, Hofmann KK, Conzen P, et al. A rational approach to perioperative fluid management [J]. Anesthesiology,2008,109(4):723-740.
[12]Brandstrup B,Tonnesen H,Beier holgersen R,et al.Effects of intravenous fluid restriction on postoperative complications:comparison of two perioperative fluid regimens:a randomized as-sessor blinded multicenter trial[J].Ann Surg,2003,238 (5):641-648.
[13]Wenkui Y, Ning L, Jianfeng G, et al.Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malig-nancy[J]. Surgery,2010,147(4):542-552
[14]Concha MR, Mertz VF, Cortinez LI, et al. The volume of lactated Ringer's solution required to maintain preload and cardiac index during open and laparoscopic surgery[J]. Anesth Analg,2009,108(2):616-622
[15]Kimber O, Arnberger M, Brandt S, et al. Goal-directed colloid administration improves the microcirculation of healthy and perianastomotic colon[J]. Anesthesiology,2009,110(3):496-504
[16]Bundgaard NM, Ruhnau B, Secher NH, et al. Flow related techniques for preoperative goal directed fluid optimization[J]. Br J Anaesth,2007,98 (1):38-44.
[17]Soni N. British consensus guidelines on intravenous fluid therapy for adult Surgical patients (GIFTASUP):cassandra's view[J].Anaesthesia,2009,64(3):235-238.
[18]Shoemaker WC, Printen KJ, Amato JJ, et al. Hemodynamic patterng after acute anesthetized and unanesthetized trauma. Evaluation of the consequence of changes in cardiac output and derived calculations. Arch Surg,1967,95(3):492-499.
[19]Shoemaker WC, Montgomery ES, Kaplan E, et al. Physiologic patterns in surviving and nonsurviving shock patients. Use of sequential cardiorespiratory variables in defining criteria for therapeutic goals and early warning of death. Arch Surg,1973,106(5):630-636.
[20]Gattinoni L, Braszi L, Pelosi P, et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. Sv02 Collaborative Gronp. N Engl J Med,1995, 333(16):1025-1032.
[21]Rivers E,Nguyen B,Havstad S, et al. Early coal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med,2001,345(19):1368-1377.
[22]Hollenberg BM, Ahrens TS, Annane G, et al. Practice parameters for hemodynamic support of sepsis in adult patients:2004 update. Critical Care Medicine, 2004, (22):1928-1948
[23]Kumar, Ariel R, Bunne JE, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance or the response to volume infusion in normal subjects. Crit Care Med,2004, (32):691—699.
[24]Shah MR, Easselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients:meta analysis of randomized clinical trials JAMA, 2005,294(13):1664-1670.
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