摘要
重症患者前负荷、后负荷及心肌收缩力均发生较大改变,且三者相互影响,准确监测并判断患者血流动力学变化成为了当前临床工作面临的重大挑战。近十年来,血流动力学监测经历了从有创到微创这一阶段,并逐渐朝无创方向发展。基于菲克原理的心输出量(CO)检测仪作为CO唯一测定金标准,但其价格昂贵,且专业性高,而基层医疗机构无论是在硬件条件或医疗技术方面均难以实现,导致推广受限。经肺动脉导管(PAC)热稀释法这一金标准虽能完成长时间监测,但其所测的CO数据并不具备实时性,有一定时间的滞后性,同时肺动脉导管属有创性检查,不仅不适合长时间反复多次操作,也增加了监测费用,并不能改善重症患者预后,上述原因导致PAC在临床使用中受到了很大限制。因此,积极探索一种更为快捷、高效、安全的CO监测方法是临床当务之急。无创血流动力学监测凭借其安全无创性、操作简单获得了广大患者青睐。本文对临床常用到的几种无创血流动力学监测仪应用进展进行综述,以期为重症患者的血流动力学指标的临床监测提供指导。
Critically ill patients experience significant changes in preload,afterload and myocardial contractility,which interact with each other.Accurately monitoring and assessing changes in patient hemodynamics has become a major challenge in current clinical practice.In the past decade,hemodynamic monitoring has gone through the stage from invasive to minimally invasive and gradually developed towards non-invasive direction.The cardiac output(CO)detector based on Fick's principle is the only gold standard for CO measurement,but it is expensive and highly specialized.However,it is difficult for primary healthcare institutions to achieve in terms of hardware conditions and medical technology,which limits its promotion.Although the thermal dilution method of pulmonary artery catheterization(PAC),which is the gold standard,can achieve long-term monitoring,the CO data measured by it does not have real-time performance and has a certain time lag.At the same time,pulmonary artery catheterization is an invasive examination,which is not suitable for long-term repeated operations,also increases monitoring costs,and cannot improve the prognosis of critically ill patients.The above reasons have greatly limited the clinical use of PAC.Therefore,actively exploring a faster,more efficient,and safer method for CO monitoring is a clinical priority.Non-invasive hemodynamic monitoring has gained popularity among patients due to its safety,non invasiveness,and simple operation.This article reviews the application progress of several non-invasive hemodynamic monitoring devices commonly used in clinical practice,in order to provide guidance for the clinical monitoring of hemodynamic indicators in critically ill patients.
作者
张月静
ZHANG Yue-jing(Intensive Care Medicine Department,Tianjin Beichen District Traditional Chinese Medicine Hospital,Tianjin 300400,China)
出处
《中国城乡企业卫生》
2025年第6期28-31,共4页
Chinese Journal of Urban and Rural Enterprise Hygiene
关键词
血流动力学监测
无创
应用效果
Hemodynamic monitoring
Non-invasive
Application effects
作者简介
通信作者:张月静,本科,主管护师,主要从事重症疾病临床护理工作,E-mail:zzy461498956@163.com。
