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測量補液反應指標 Fluid responsiveness


老一代的補液挑釁試驗 fluid chanllenge, CVP有 5-2 rule, PCWP 有 7-3 rule,這些將靜態指標,尤其又是以壓力代替容量的指標surrogate,會有一定的誤差與偏移。

Early goal directed therapy, 在敗血症sepsis治療中,也是依照所有休克的治療原則,補液,強心,擴血管,無疑的,fluid resuscitation在危重症病人,是一個最重要的課題,補液不當,太少,太多,都不利於機體機能,
而通常又會補液過多fluid overload,表現在臨床,就是全身性水腫,尤其是胸部(實質,或胸膜腔),Starling - curve 是病生理的理論基礎,preload為指標,SV stroke volume,或CI cardiac index為目標,肺動脈導管置放術 PAC pulmonary artery cathertarization,可以提供全心功能參數 cardiac performance parameter,包括SV, CI,SVRI不過循證醫學的證據顯示,PAC的置放反而不利於危重病人的最終結果outcome,因此,近來微創型血型力學監測儀minimal hemodynamical monitoring,應運而生,趨勢是:動態的指標如SPV, PPV, SVV,可能比靜態指標如CVP, PCWP, LVEDAI(left ventricular end diastolic  area index),GEDVI等,還能代表身體的補液反應 Fluid responsiveness.

九月份的

Critical care medicine一篇system review papaer:

Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: A systematic review of the literature. Cri. Care Med. 2009; 37(9):2642-7


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