围手术期血流动力学监测进展

The research advance of perioperative hemodynamic monitoring

背景围手术期血流动力学可出现较大波动，可导致不可预料的风险，故围手术期血流动力学监测一直是医学研究者的关注重点。目的总结近年来血流动力学监测方面的进展，并阐述其优势及局限性，为临床上选择合适的血流动力学监测提供参考。内容近年来在传统监测方法的基础上，研发出了许多新型血流动力学监测方法，其中无创监测方法重点阐述新型的血流动力学监测手段，如无创血流动力学监测仪（noninvasivecardiacoutputmonitor，NICOM）、C02重复吸入法心排血量测定（non-invasiveC02rebreathingcardiacoutputmonitoring，NIC02）、无创超声心排血量监护（ultrasoniccardiacoutputmonitoring，USCOM）、t线连续无创血压监测仪（T-LINEtensymeter，T-LINE）、连续无创血压监测（continuousnon-invasivebloodpressuremonitoring，CNBP）等新型微创或者连续无创血压监测系统（continuousnon-invasivearterialbloodpressuremonitoring，CNAP）；有创监测手段则侧重阐述更微创化的技术，如经食管超声心动图（transesophagealechocardiography，TEE）、脉搏指示连续心排血量监测（pulseindicatorcontinuouscardiacoutput,PiCCO）技术、动脉脉搏波形法连续心排血量监测（arterialpressurewaveformanalysisCO，APCO）等。趋向临床上应根据实际条件及监测要求选择相应监测手段。微创血流动力学监测和无创及传统有创血流动力学监测相比，并发症少、创伤小、实时性和精确性高，在未来围手术期血流动力学监测中有着广阔的应用前景。

Background Hemodynamics of patients in perioperative period could fluctuate in an extremely wide range, and the fluctuation beyond normal range sometimes is life-threatening. Therefore, hemodynamic monitoring is an important issue in perioperative care. Objective To summarize the research advance of perioperative hemodynamic monitoring. Content Several noninvasive and invasive methods have been developed for hemodynamic monitoring. Non-invasive monitoring methods include noninvasive cardiac output monitoring （NICOM）, non-invasive CO2 rebreathing cardiac output monitoring （NICO2）, ultrasonic cardiac output monitoring（USCOM）, T-LINE tensymeter（T-LINE）, continuous non-invasive blood pressure monitoring（CNBP） and continuous non-invasive arterial blood pressure monitoring （CNAP）. Invasive monitoring methods consist of transesophageal echocardiography （TEE）, pulse index continuous cardiac output （PiCCO）, arterial pressure waveform analysis of cardiac output （APCO）. This review introduces the basic principles, clinical applications, and advantages and disadvantages of each methods to provide guidance for clinical practitioners to select suitable methods for hemodynamic monitoring in individual patients during anesthesia. Trend Minimal or no invasion/complication, real-time, and accuracy are three requirements for optimized hemodynamic monitoring. Additionally, cautions need to be taken to select appropriate perioperative hemodynamic monitoring method for patients with various medical conditions.