俯卧位下每搏量变异度评估脊柱手术患者血容量状态的准确性：FloTrac/Vigileo法与Picco-plus法  

Accuracy of stoke volume variation in prone position for assessment of blood volume in patients undergoing spine surgery： determination using FloTrac/Vigileo and Picco-plus technologies

作　　者：李雪[1] 胡晓[1] 朱赛楠[2] 

机构地区：[1]北京大学第一医院麻醉科,100034 [2]北京大学第一医院统计室,100034

出　　处：《中华麻醉学杂志》2015年第2期185-190,共6页Chinese Journal of Anesthesiology

摘　　要：目的 评价俯卧位下FloTrac/Vigileo法及Picco-plus法测定的每搏量变异度（SVV）评估脊柱手术患者血容量状态的准确性.方法 择期行后路腰椎手术或侧弯矫形术的患者43例,年龄＞18岁,性别不限,体重40～100 kg,ASA分级Ⅰ-Ⅲ级.麻醉诱导后,分别在仰卧位及俯卧位状态下进行1次液体反应性试验：经10 min快速静脉输注羟乙基淀粉130/0.4氯化钠注射液5 ml/kg.同时采用Picco-plus系统和FloTrac/Vigileo系统测定SVV（SVVP和SVVF）.将Picco-plus系统测得的△SVI≥10％作为液体反应阳性的判定标准.根据△SVI≥10％和＜10％将患者分为反应组（Rs组）和无反应组（NRs组）.对SVV作ROC曲线并计算诊断阈值、曲线下面积及95％可信区间（CI）.结果 共41例患者纳入本次分析.仰卧位下预测液体反应性的ROC曲线下面积：SVVF为0.740（95％CI：0.568～0.913）,诊断阈值为12％,判断液体反应性的灵敏度为86％,特异度为54％;SVVP为0.637.俯卧位ROC曲线下面积：SVVF为0.451,SVVP为0.634.与Rs组比较,NRs组仰卧位扩容前SVVF的基础值较低（P＜0.05）,其余血流动力学指标差异无统计学意义（P＞0.05）;俯卧位扩容前2组血流动力学指标差异无统计学意义（P＞0.05）.结论 俯卧位下FloTrac/Vigileo系统及Picco-plus系统测定的SVV均不能准确评估脊柱手术患者的血容量状态.Objective To evaluate the accuracy of stoke volume variation （SVV） determined using FloTrac/Vigileo and Picco-plus technologies in prone position for assessment of the blood volume in the patients undergoing spine surgery,Methods Forty-three ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 〉 18 yr,weighing 40-100 kg,scheduled for elective posterior approach to lumbar spinal fusion or scoliosis surgery were studied.After induction of anesthesia,a volume expansion was performed in supine and prone positions.Hydroxyethyl starch 130/0.4 sodium chloride injection 5 ml/kg was rapidly infused intravenously over 10 min to carry out the test for fluid responsiveness.Picco-plus and FloTrac/Vigileo systems were simultaneously applied in every subject to measure SVV （SVVP and SVVF）.Positive fluid responsiveness was defined as the changing rate of stroke volume index ≥ 10% as measured by using Piccoplus system.The patients were divided into response group （Rs group） and non-response group （NRs group） according to the changing rate of stroke volume index ≥ 10% and 〈 10%.The receiver operating characteristic （ROC） curve for SVV was plotted,and the diagnostic threshold,area under the ROC curve and 95% confidence interval （CI） were calculated.Results Forty-one patients were included for analysis in this study.In supine position,the area under the ROC curve for SVV in predicting the fluid responsiveness was 0.740 （95% CI：0.568-0.913）,the diagnostic threshold was 12%,and the sensitivity and specificity in determining fluid responsiveness were 86% and 54%,respectively,for SVVF,and the area under the ROC curve was 0.637 for SVVP.In prone position,the area under the ROC curve was 0.451 for SVVF,and 0.634 for SVVP.Compared with Rs group,the baseline value of SVVFwas significantly lower,and no significant change was found in the other hemodynamic parameters before volume expansion in supine position in NRs group.There was no significant difference in the hemodynamic parameters before volume e

关 键 词：每搏输出量 血管容量 俯卧位 监测 生理学 

分 类 号：R614[医药卫生—麻醉学]