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非侵入性目标导向流体治疗与充满可变性指数 (PVI):系统性审查和元分析

Vitor Alves Felippe¹, Roberta Codeceira², Maria Irigaray³

¹Department of Anesthesiology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil.

Journal of clinical monitoring and computing

|August 8, 2025

概括

与传统的流体管理相比,在非心脏手术中,Pleth变量指数 (PVI) 引导的流体治疗显著减少了手术内流体和晶体剂的使用. 这种方法优化了外科手术期间的流体管理,而不会影响患者的稳定性.

科学领域:

麻醉学和外科手术期间的医学.
关键护理医学关键护理医学
手术结果研究研究.

背景情况:

优化手术内流体管理对于改善手术结果和减少并发症至关重要.
动态的,非侵入性指标,如位变性指数 (PVI) 被探索为目标导向的流体治疗.
传统的流体管理 (CFM) 实践各不相同,可能导致流体管理不足最佳水平.

研究的目的:

在非心脏手术中,系统地审查和元分析PVI导向液体治疗与CFM的有效性.
评估PVI指导对流体体积,血液动力学稳定性和临床结果的影响.
评估PVI在优化外科周流体管理中的作用.

主要方法:

从PubMed,Embase和Cochrane数据库中对研究进行系统审查和元分析,直到2024年1月.
包括9项涉及1,105名接受非心脏手术的患者的研究.
使用随机效应模型分析了手术内液体总量,晶体施用,血液动力学参数,功能,酸平衡和住院时间 (LOS).

主要成果:

与CFM相比,PVI导向治疗显著降低了总液体体积 (MD-761.23毫升) 和晶体剂 (MD-655.05毫升).
在合物使用,尿液输出,上腺素需求,动脉压,酸平衡或LOS方面没有观察到显著差异.
在腹部手术中的子组分析证实了液体体积的减少.

结论:

以PVI为指导的流体管理可以实现更具限制性和个性化的外科手术期间流体策略.
这种方法优化了液体的管理,而不会对血液动力学或代谢稳定性产生不利影响.
PVI显示了临床价值为外科手术期间流体优化,特别是当侵入性监测是有限的,虽然进一步研究长期的结果是合理的.

关键词:

目标导向的流体治疗进行元分析分析.周期操作流体管理系统普莱斯波动性指数 (PVI)系统性审查系统性审查

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