操作室流体响应的动态参数:对手术内通风框架条件的分析
M Prütz1, A Bozkurt2, B Löser2
1Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany. maria.pruetz@med.uni-rostock.de.
Die Anaesthesiologie
|June 28, 2024
概括
很少有患者在手术期间满足脉冲压变化 (PPV) 流体响应评估标准. 像潮体积 (TV) 和正极呼气压 (PEEP) 这样的通风设置通常与PPV要求相冲突.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
背景情况:
- 脉冲压变化 (PPV) 是流体响应性的关键指标.
- PPV的可靠性取决于特定的通风参数,这些参数可能与保护性通风策略相冲突.
研究的目的:
- 评估PPV在非心脏手术患者中的适用性.
- 分析手术内通风数据以确定PPV的适用性.
主要方法:
- 对来自三个医疗中心的10,334名患者的手术内通风数据的回顾性分析.
- 从电子病历中提取的数据,包括通风参数,人口统计和病史.
主要成果:
- 只有6.3%的麻醉记录显示平均潮体积 (mTV) > 8毫升/公斤预测体重 (PBW),这是PPV的标准.
- 腹部手术患者 (75.5%) 很少接受mTV> 8毫升/公斤PBW (5.5%),无论手术方法 (腹腔镜 vs 开放).
- 增加PEEP和呼吸速率也被确定为PPV使用的障碍.
结论:
- 该研究表明,很少有手术患者符合基于PPV的流体响应性评估所定义的潮体积标准.
- 目前的通风实践往往阻止在非心脏手术中可靠使用PPV.
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