心功能监测方法在临床中的应用

心脏手术围术期血流动力学易发生较大波动,若不及时发现及迅速纠正血流动力学紊乱,将导致灾难性地后果,因此,心功能监测在心脏手术围术期极为重要。关于心功能监测的方法一直都是研究的重点,以期应用最安全、最快速地技术获取最准确地监测以指导血流动力学治疗,改善患者预后。近年来,国内外学者为达最优化的心功能监测,在传统监测方法(肺动脉导管)基础上,研发了许多新型监测技术,如脉搏指示连续心排量(Pulse-indicated continuous cardiac output,PiCCO)、锂稀释心排量(Lithium-indicated dilution cardiac output,LiDCO)、FloTrac/Vigileo、ProAQT/PulsioFlex监测系统、经食管多普勒(Transesophageal doppler,TD)、Nexfin、无创超声心排量监测(Ultrasonic cardiac output monitoring,USCOM)、经胸生物电阻抗(Thoracic electrical bioimpedance,TEB)等,临床上应根据实际条件及监测要求选择适当的方法。本文介绍每种方法的基本原理、临床应用以及优缺点,为心功能监测在临床中的应用提供新思路。

Application of cardiac function monitoring method in clinic

Perioperative hemodynamics of cardiac surgery are prone to large fluctuations.If hemodynamic disorders are not detected and quickly corrected in time,it will lead to catastrophic consequences.Therefore,cardiac function monitoring is extremely important in the perioperative period of cardiac surgery.The method of cardiac function monitoring has always been the focus of research,in order to apply the safest and fastest technology to obtain the most accurate monitoring to guide hemodynamic therapy and improve patient prognosis.In recent years,scholars at home and abroad have developed many new monitoring technologies based on traditional monitoring methods (pulmonary artery catheters)in order to achieve optimal cardiac function monitoring,such as pulse-indicated continuous cardiac output (PiCCO),lithium-indicated dilution cardiac output (LiDCO),FloTrac/Vigileo,ProAQT/PulsioFlex monitoring system,transesophageal Doppler (TD),Nexfin,non-invasive ultrasound cardiac output monitoring (ultrasonic cardiac output monitoring) Output monitoring (USCOM),transthoracic electrical bioimpedance (TEB),etc.,which should be selected clinically according to actual conditions and monitoring requirements.This article introduces the basic principles,clinical applications,advantages and disadvantages of each method,and provides new ideas for the clinical application of cardiac function monitoring.