协和医学杂志

2019, v.10(05) 433-437

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临床血流动力学30年
Thirty Years of Clinical Hemodynamics

刘大为;
LIU Da-wei;Department of Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

从肺动脉漂浮导管第一次介绍到中国开始,临床血流动力学在我国已经发生了天翻地覆的变化。从监测指标的临床应用,到对血流动力学理论的系统认识;从仅限于循环系统内,到指标遍布整个机体;从对血流动力学无处不在的临床认识,到对重症治疗每一个细节的把控;从对临床治疗与再损伤的认识,到通过血流动力学指标对临床行为的定量管理;终于使血流动力学监测走向治疗。继而,在此基础上,新指标的出现不仅拓宽了视野,并导致对已有体系的重新认识。血流动力学连续与动态特征和目标与目的的实施策略可以付诸实践,才使得"临床血流动力学治疗"的概念,以完整的理论体系、规范的临床应用,终于破茧而出。在深入地植根于临床实践后,今天的临床血流动力学治疗正在从微循环走向器官功能,从个体化走向器官化。
Tremendous development and progress in clinical hemodynamics have been made since 30 years ago when the first Swan-Ganz Cather was introduced to China. The emerging concept of clinical hemodynamic therapy( CHT) is enriched today in its theoretical system and clinical feasibility. CHT includes some new concepts,such as that hemodynamics is a discipline defining the state of both blood flow and blood component flowing inside and outside of the cardiovascular system. CHT is not as same as hemodynamic monitoring because of its characteristics and its control capability in clinical behavior,which include some key points like therapeutic timing and targeting,interventional therapy,and concomitant injury. The therapeutic target is at the interaction among organs and has changed from personalized therapy to organ-target directed therapy. CHT is a goal-directed,quantitative treatment process in accordance with the patient's real-time status and response to the intervention based on hemodynamic theories.

关键词(KeyWords): 临床血流动力学;重症医学;治疗
clinical hemodynamics;critical care medicine;treatment

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作者(Author): 刘大为;
LIU Da-wei;Department of Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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