每日一题_2022.08.14

In which of the following patients would use of a conventional pulse contour monitoring device measuring stroke volume variability and cardiac output provide the most reliable data?

A. Cirrhotic patient with severe sepsis who is tachypneic

B. Septic intubated patient with severe acute respiratory distress syndrome receiving lung protective strategy with tidal volume of 5 mL/kg

C. Patient under general anesthesia in sinus rhythm undergoing major intra-abdominal surgery with prolonged cavity exposure and expected to lose a moderate volume of blood

D. Patient status post large acute anterior myocardial infarction on pressors with an intra-aortic balloon pump

E. Patient with a large pulmonary embolus who is tachycardic with multifocal atrial tachycardia

答案解析：

每搏输出量变化和心输出量测量的常规监测器高度依赖于主动脉脉搏轮廓进行测量。 改变逐搏心脏负荷条件的心律失常将影响测量的可靠性，通过改变舒张波形使用主动脉内球囊泵也会影响测量的可靠性。 与低血管阻力相关的条件对于这些装置也是有问题的。 呼吸波形的周期性变化，如在自主呼吸患者或表现出严重肺部不顺应性的急性肺病患者中所预期的那样，也会影响测量的可靠性。 当患者使用潮气量至少为 8 mL/kg 的呼吸器时，通常建议使用监测仪。 因此，没有心律失常的术中患者在麻醉下接受控制通气是这种监测设备最理想的条件。

正确答案：C