Frank-Starling曲线与容量管理.PDF

2015年11月第35卷第11期 中国实用内科杂志 887 • 专题笔谈 脓毒症治疗:基础与临床 Frank-Starling曲线与容量管理 杜　微，刘大为 DOI：10.7504/nk2015100101 中图分类号：R631+.4 文献标识码：A 摘要 ：Frank-Starling 定律是指静脉回心血量提供给心脏前负荷的多少决定心脏每搏输出量。影响曲线的因素包括 心室前负荷、心肌收缩力、心室后负荷、体位因素、体温等。从生理学角度 Frank-Starling 曲线和静脉回流曲线相对位 置决定患者有无容量反应性。在临床中，判断患者的容量状态是否在曲线的上升支的方法包括容量负荷试验、基于 心肺相互关系理论衍生参数，和自体模拟输液等方法。容量管理的流程是基于 Frank-Starling 曲线内涵而衍生的容 量复苏的“金三角”，该方法使复苏效果最大化，同时最大程度减少容量过负荷导致的副反应。 关键词 ：容量反应性 ；容量治疗 ；心血管生理 Frank-Starling curve and capacity management.　　DU Wei, LIU Da-wei. Department of Intensive Care Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China Corresponding author: LIU Da-wei, E-mail: dwliu98@163.com Abstract: The Frank–Starling mechanism describes the relationship between stroke volume and preload to the heart, or the volume of blood that is available to the heart—the venous return. The factors influencing the curve including include ventricular preload, myocardial contraction, ventricular afterload, position, temperature, etc. Whether patients are with or without responsiveness is decided by the intersection location of Frank–Starling curve and venous return curve intersection location decided to patients with or without fluid responsiveness. In clinicalClinically, we judge the volume responsiveness methods includingby volume-load test, fluid challenge, during positive pressure breathing by variations in left ventricular output using numerous surrogate markers during positive pressure breathing, and simulation methods of autologous transfusion simulation. The fluidVolume capacity management process which is the “