休克的治疗:血流动力学启示录

Shock:the Revelation from Critical Hemodynamic Therapy

休克,虽已被临床认识和治疗多年,但仍是常见的危及生命的疾病状态。重症血流动力学为休克治疗提供了具体指导和新的启示。血流动力学是研究血液及其组成成分在机体内运动特点和规律的科学。与监测不同,重症血流动力学治疗是以血流动力学理论为基础,根据机体实时状态和反应,目标导向的定量治疗过程。重症血流动力学治疗基本原则和理念时刻在影响着休克治疗方法的选择和实施。首先,在选择反馈性指导治疗指标时,应保证流量指标的最高优先等级,但应注意每个血流动力学指标只要测量准确,均具有临床应用价值;其次,右心功能改变在休克中具有重要意义,右心功能管理在休克治疗中已成为不可忽视的重要环节;再次,休克治疗中需保持尽可能低的中心静脉压,与传统将压力指标代替容量不同,中心静脉压具有明确的临床指导意义;最后,重症血流动力学不仅仅是支持性治疗,而是包括从休克病因到预后的全过程治疗。

Shock,which has been recognized and treated in clinic for a long time,however,is a commonly seen lethal morbid state. The development of hemodynamics in critical care provides specific guidance and novel inspirations. Hemodynamics is a discipline defining the movement of blood flow and blood components inside and outside of cardiovascular system. Hemodynamic treatment in critical care is a quantitatively goal-oriented approach based on the theories of hemodynamics,according to the patient＇s real-time status and response to the intervention. Hemodynamic principles and concepts influence the choice and performance of treatment on shock. Firstly,flow indicator should be ensured the top priority at selecting feedback parameters for treatment. Meanwhile,be aware that,every hemodynamic indicator,so long as it is correctly measured,is of value in clinical practice. Secondly,the change of right heart function is of great importance in shock. Managing the right heart function has become an indispensible part in the treatment. Thirdly,the central venous pressure needs to be kept as low as possible in shock patients. Central venous pressure,which is different from the traditionally used pressure parameter instead of flow,is of significance in definitely guiding the treatment.Fourthly,critical hemodynamic therapy is not merely limited to supportive treatment,but encompasses the whole set of management of shock from etiology to prognosis.