CAJ | 학술논문

对于急性循环衰竭患者,特别是感染性休克患者,液体治疗对于血流动力学的稳定、组织器官的血流灌注、纠正细胞缺氧、对抗感染十分重要,但过多增加液体量对危重症患者,特别是脓毒血症和/或肺损伤患者是有害的,如何选取合适的指标指导临床合理输液仍面临许多挑战.评估容量反应性可避免盲目补液,降低补液风险.回顾关于评估容量反应性的指标及临床报道,静态血流动力学参数,如中心静脉压、肺毛细血管楔压,虽常用但受干扰因素多,无法及时准确地评估循环血容量的变化.基于心肺相互作用的功能性血流动力学监测指标,如脉压变异和每搏量变异,虽广泛应用,但因自主呼吸、心律失常、低潮气量或低肺顺应性等局限性,不能用于所有患者.呼气末屏气试验、微量静脉输液、被动抬腿试验成为有自主呼吸运动和/或心律失常情况下评估容量反应性的备选方法,其可靠性及局限性值得进一步研究.
대우급성순배쇠갈환자,특별시감염성휴극환자,액체치료대우혈류동역학적은정、조직기관적혈류관주、규정세포결양、대항감염십분중요,단과다증가액체량대위중증환자,특별시농독혈증화/혹폐손상환자시유해적,여하선취합괄적지표지도림상합리수액잉면림허다도전.평고용량반응성가피면맹목보액,강저보액풍험.회고관우평고용량반응성적지표급림상보도,정태혈류동역학삼수,여중심정맥압、폐모세혈관설압,수상용단수간우인소다,무법급시준학지평고순배혈용량적변화.기우심폐상호작용적공능성혈류동역학감측지표,여맥압변이화매박량변이,수엄범응용,단인자주호흡、심률실상、저조기량혹저폐순응성등국한성,불능용우소유환자.호기말병기시험、미량정맥수액、피동태퇴시험성위유자주호흡운동화/혹심률실상정황하평고용량반응성적비선방법,기가고성급국한성치득진일보연구.
For patients with acute circulatory failure,particularly with septic shock,fluid administration is crucial for the steady of hemodynamic and tissue oxygen consumption,but excessive fluid administration is deleterious in critically ill patients,particularly in case of sepsis and/or lung injury.Thusassessment of volume responsiveness before deciding to administer volume expansion is of great importance,for the purpose of avoiding blind fluid administration.Through reviewing all the indicators and clinical reports about volume responsiveness,static hemodynamic parameters,such as central venous pressure and pulmonary capillary wedge pressure,which have been used for many years,lose their predictive value because of some limitations.And functional hemodynamic monitoring indexes,such as pulse pressure variation and stroke volume variation,which are based on the heart-lung interactions,cannot be used in cases of spontaneous breathing activity,cardiac arrhythmias,low tidal volume or low lung compliance.Thus the end-expiratory occlusion,"mini" fluid challenge,and the passive leg-raising test can be used as alternative methods,solving the problem of prediction of volume responsiveness in cases of spontaneous breathing activity and/or cardiac arrhythmias,but the dependability and limitation are in the further research.