CNAP-PPV目标导向的血流动力学治疗
专家肯定
“CNAP-PPV可以拓展目标导向液体管理的益处,使之不仅可以用于高风险手术、动脉插管或者多普勒监测的手术中,更可以广泛应用于临床。这就使得液体管理变成了一个真正的、常规的临床标准,让麻醉中的病人获益。”
—— Prof.Benoit Vallet, Chair of the Deparment ofAnesthesiology and Intensive Care, University Hospital Lille, France
临床价值及益处:
“PPV已经表现出强大的临床应用潜力:通过无创方式获得的生理参数来帮助优化血流动力学。如今的PPV可以帮助全身麻醉机械通气下的病人进行液体治疗和血流动力学优化。”[1]
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在全身麻醉机械通气的病人中,血流变异性如脉压变异度是最好的预测液体反应性的参数[2-4]。
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在所有指示液体管理的参数中,脉压变异率PPV拥有最多的临床验证基础[3.5]。
方法及计算原理:
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CNAP-PPV是一个动态的、无创的指导液体管理的参数,是通过动脉血压波形计算得到的。
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应用条件:
机械通气(呼气末正压PEEP < 5 cm H2O, 潮气量 > 8ml/kg)
窦性心律
闭胸条件
准确、可靠:
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无创的CNAP-PPV是一个准确的预测麻醉病人液体反应性的因子[7.8]。
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敏感性和特异性可以与有创穿刺相比[7]。
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数据准确性及动态波形可以与有创穿刺监测方法媲美[9]。
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唯一组合血压和血流动力学PPV的无创设备。
无创、连续:
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无风险
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操作启动快速、简单
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更少的并发症,提高患者预后[6.10]
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减少病人在ICU和医院的停留时间[6]
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帮助减少医疗费用
“…… 在心脏外科手术中,运用CNAP无创指套监测的脉压变异率PPV与有创动脉插管测量的PPV相关性非常接近。”[7]
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参考文献:
1 Cannesson, M., etal., Pulse pressure variaton: Where are we today? Journal of ClinicalMonitoring and Computing. doi: 10.1007s10877-010-9229-1 (2010).
2 Marik, PE, et al., Haemodynamic parameters to guide fluid therapy. AnnIntensive Care. 1:1 (2010).
3 Marik, PE, et al., Dynamic changes in arterial waveform derived variables andfluid responsiveness in mechanically ventilated patients: a systematic reviewof the literature. Crit Care Med 37:2642-7 (2009).
4 Maguire, S., et al., Respiratory Variation in Pulse Pressure andPlethysmographic Waveforms: Intraoperative Applicability an a North AmericanAcademic Center. Anesthesia and analgesia (2011).
5 Cannesson, M., Arterial pressure variation and goal-directed fluid therapy. JCardiothorac Vasc Anesth. 24:487-97 (2010).
6 Lopes, M., et al., Goal-directed fluid management based on pulse pressurevariation monitoring during high-risk surgery: a pilot randomized controlledtrial. Critical Care. doi:10.1186/cc6117 (2007).
7 Biais, M., et al., The ability of pulse pressure variations obtained withCNAP™ device to predict fluid responsiveness in the operating room; Anesthesiaand analgesia, 523-28 (2011).
8 Monnet, X. et al., Prediction of fluid responsiveness by a continuousnon-invasive assessment of arterial pressure in critically ill patients:comparisonwith four other dynamic indices. British Journal of Anaesthesia (2012).
9 Jeleazcov et al., Precision and accuracy of a new device (CNAP) forcontinuous non-invasive arterial blood pressure monitoring: assessment duringgeneral anesthesia. British Journal of Anesthesia 2010 vol. 105 (3) pp. 264-72.
10 Michard, F., et al. Rational fluid management: dissecting facts fromfiction. BJA. 108(3):369-71 (2012)
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