每搏变异度监测腹腔黏液瘤高腹压患者血容量变化的准确性研究  

Accuracy of blood volume change monitored by stroke volume variation in the patient of pseudomyxoma peritonei with intra-abdominal hypertension

作　　者：杨占民[1] 郑翔丽[1] 陆良愿 Yang Zhanmin;Zheng Xiangli;Lu Liangyuan(Department of Anesthesiology, Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院麻醉科,北京100049

出　　处：《北京医学》2018年第11期1052-1055,1060,共5页Beijing Medical Journal

摘　　要：目的评价每搏变异度(stroke volume variation, SVV)监测腹腔黏液瘤高腹压患者血容量变化的准确性。方法选取择期行腹腔黏液瘤减瘤手术患者36例,男20例,女16例,年龄32～65岁,体质量51～77 kg,美国麻醉师协会(American Soviety of Anesthesiologists, ASA)分级Ⅰ～Ⅲ级。麻醉诱导后插入气管导管,行双肺机械通气,分别于插管后10 min和腹腔减压后10 min时进行容量负荷试验,以0.4 ml/(kg·min)速率输注6%羟乙基淀粉130/0.4氯化钠注射液(万汶),总量7 ml/kg。插管后10 min输注液体前即刻和输注液体结束后,腹腔减压后10 min输注液体前即刻和输注液体结束后,分别记录MAP、HR、中心静脉压(central venous pressure, CVP)、心指数(cardiac index, CI)和SVV,计算SVV和CI的变化率(ΔSVV和△CI)。ΔCI>15%为扩容有效,绘制SVV判断血容量变化的ROC曲线,计算AUC及其95%CI。结果腹腔黏液瘤患者未减压前△SVV与△CI呈负相关,相关系数为-0.741(P <0.05)。ROC曲线分析结果示,SVV监测血容量变化的AUC为0.953(95%CI:0.888～1.000),诊断阈值为12.5%,灵敏度为84.2%,特异度为81.9%。腹腔黏液瘤患者减压后△SVV与△CI呈负相关,相关系数为-0.603(P <0.05)。ROC曲线分析结果示,SVV监测血容量变化的AUC为0.896(95%CI:0.783～1.000),诊断阈值为9.5%,灵敏度为78.9%,特异度为63.6%。结论 SVV作为监测腹腔黏液瘤患者围术期血容量变化的指标优于心率和血压,但诊断阈值有所改变。Objective To evaluate the accuracy of blood volume change monitored by stroke volume variation(SVV) in the patient of pseudomyxoma peritonei(PMP) with intra-abdominal hypertension. Methods Thirty-six patients who were planned to receive cytoreductive surgery were selected into study, included 20 males and 16 females, with American Society of Anesthesiologists(ASA) gradeⅢ~Ⅲ, age from 32 to 65 years, weight of 51~77 kg. Patients were maintained with target controlled infusion(TCI) after induction of intubation under general anesthesia. Patients were controlled ventilation(tidal volume 8 ml/kg, respiratory rate 12 beat per minute, Inspiratory: Expiratory 1∶1.5, FiO2100%).PETCO2 was maintained between 35~40 mm Hg. Radial artery was cannulated to monitor invasive blood pressure(IBP),cardiac index(CI), and SVV by using Flo-Trac vigileo system. Internal jugular vein was cannulated for central venous pressure(CVP). Volume-loading tests were conducted 10 min after intubation and 10 min after abdominal decompression respectively, and 6% hydroxyethyl starch was injected at a rate of 0.4 ml/(kg· min). The total fluid volume was 7 ml/kg.MAP, HR, CVP, CI and SVV were recorded before and 3 min after fluid therapy. A rate of change of CI greater than 15%was considered effective for capacity expansion. The ROC curve of SVV reflecting the volume expansion efficacy was plotted to confirm the diagnostic threshold. Results There was a negative correlation between ΔSVV and ΔCI before abdominal decompression, the correlation coefficient was-0.741(P<0.05). The ROC curve showed that the AUC of SVV change was 0.953(95% CI: 0.888~1.000), with diagnostic threshold of 12.5%, sensitivity of 84.2% and specificity of81.9%. After abdominal decompression, there was negative correlation between ΔSVV andΔCI, and the correlation coefficient was-0.603(P<0.05). The ROC curve showed that the AUC of SVV change was 0.896(95% CI: 0.783~1.000),with diagnostic threshold of 9.5%, sensitivity of 78.9% and specificity of 63.6%. Conclusions SVV is be

关 键 词：每搏变异度 容量治疗 腹腔黏液瘤 高腹压 

分 类 号：R735[医药卫生—肿瘤] R614[医药卫生—临床医学]