低潮气量通气患者每搏量变异度监测液体反应准确性的研究  

Stroke Volume Variation for Prediction of Fluid Responsiveness in Patients Undergoing Ventilation with Low Tidal Volume

作　　者：邓佳[1] 许婷[1] 蔡兵[1] 兰志勋[1] 

机构地区：[1]四川省医学科学院.四川省人民医院麻醉科,四川成都610072

出　　处：《四川医学》2015年第7期958-960,共3页Sichuan Medical Journal

摘　　要：目的研究6m L/kg的低潮气量通气对每搏量变异度(SVV)预测液体反应的准确性的影响。方法 60例择期行腹部手术的患者随机分为两组:C组[n=30,潮气量(VT)=8m L/kg,频率(f)=12/min]和T组[n=30,VT=6m L/kg,f=16/min]。麻醉诱导后,6%羟乙基(130/0.4)7m L/kg静脉输注。除了标准的血流动力学监测,采用Flo Trac/Vigileo系统测定补液前后的SVV、心输出量(CO)、心脏指数(CI)、每搏量(SV)、每搏输出量指数(SVI)、全身血管阻力(SVR)和全身血管阻力指数(SVRI)。结果补液后,两组患者MAP、CVP、SVI和CI明显增加,而SVV和SVR明显下降。SVI与SVV正相关(C组:r=0.901;T组:r=0.737),与HR、MAP、CVP和SVR不相关。SVV的ROC曲线下面积(AUC)最大(C组0.876,T组0.789)。结论采用Flo Trac/Vigileo系统监测SVV可以准确预测6m L/kg的低潮气量通气患者的液体反应性。Objective To evaluate the acauray role of SVV in prediction of fluid responsiveness in patients undergoing ventilation with low tidal volume（ VT = 6m L / kg）. Methods Sixty patients undergoing elective abnormal surgery were randomly divided into two groups： Group C[n = 30,tidal volume（ VT） = 8 m L / kg,frequency（ f） = 12 / min]and Group T [n = 30,VT = 6m L / kg,f = 16 / min]. After anesthesia induction,6% hydroxyethyl starch130 /0. 4 solution（ 7m L / kg） was intravenously transfused. Besides standard haemodynamic monitoring,SVV,cardiac output（ CO）,cardiac index（ CI）,stroke volume（ SV）,stroke volume index（ SVI）,systemic vascular resistance（ SVR） and systemic vascular resistance index（ SVRI） were determined with the Flo Trac/Vigileo system before and after fluid loading. Result After fluid loading,MAP,CVP,SVI and CI increased significantly,whereas SVV and SVR decreased in both groups. SVI was significantly correlated to SVV（ Group C： r = 0. 901; Group T： r = 0. 737） but not HR,MAP,CVP and SVR. The largest area under the ROC curve（ AUC） was found for SVV（ Group C,0. 876; Group T,0. 789）. Conclusion SVV measured by Flo Trac / Vigileo system can accurately predict fluid responsiveness in patients undergoing ventilation with low tidal volumes（ VT = 6m L / kg）.

关 键 词：每搏量变异度 潮气量 血流动力学 液体反应性 

分 类 号：R614.1[医药卫生—麻醉学]