每搏量变异度监测腹腔镜手术患者血容量变化的准确性  

Accuracy of stroke volume variation in monitoring changes in blood volume during laparoscopic surgery

作　　者：赵艾华[1] 贾卫爱 李超[1] 贾慧群[1] 宋子贤[1] 李淑先[1] 

机构地区：[1]河北医科大学第四医院麻醉科,石家庄市050011

出　　处：《中华麻醉学杂志》2015年第4期447-449,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价每搏量变异度（SVV）监测腹腔镜手术患者血容量变化的准确性.方法 择期行腹腔镜手术患者40例,性别不限,年龄40 ～ 64岁,体重指数20～ 25 kg/m2,ASA分级Ⅰ或Ⅱ级.全麻后建立气腹,行容量负荷试验：静脉输注6％羟乙基淀粉130/0.4氯化钠注射液500 ml,输注时间30 min.于气腹前（T1）、气腹后3 min（T2）、容量负荷前即刻（T3）、容量负荷后3 min（T4）时记录心输出量（CO）、心脏指数（CI）、每搏量（SV）、每搏量指数（SVI）和SVV.以△CI≥15％为容量负荷试验阳性标准,绘制SVV判断容量变化的ROC曲线,计算曲线下面积及95％可信区间.结果 与T1时比较,T2时SVV降低（P＜0.05）;与T3时比较,T4时CO、CI、SV、SVI升高,SVV降低（P＜0.05）.ROC曲线分析结果示：SVV监测血容量变化的阈值为9.2％时,灵敏度为61％,特异度为50％,曲线下面积（95％可信区间）为0.567（0.378～0.757）.结论 SVV不适于作为监测腹腔镜手术患者血容量变化的指标.Objective To evaluate the accuracy of stroke volume variation （SVV） in monitoring the changes in blood volume during laparoscopic surgery.Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 40-64 yr,with body mass index ranged from 20 to 25 kg/m2,scheduled for elective laparoscopic surgery under general anesthesia,were studied.After induction of general anesthesia,baseline registrations of variables were obtained.After establishing pneumoperitoneum,6％ hydroxyethyl starch （HES 130/0.4） 500 ml was infused over 30 min.Before pneumoperitoneum （T1）,at 5 min after pneumoperitoneum （T2）,immediately before volume expansion （T3） and at 3 min after volume expansion （T4）,cardiac output （CO）,cardiac index （CI）,SV,stroke volume index （SVI） and SVV were monitored and recorded.The changing rate of CI （△CI） was calculated.The criterion for effective volume expansion was △CI ≥ 15％.The ROC curve for SVV in determining the volume expansion responsiveness was plotted,and the diagnostic threshold was determined.The area under the curve and 95％ confidence interval were calculated.Results SVV was significantly lower at T2 than at T1.CO,CI,SV and SVI were significantly higher,and SVV was lower at T4 than at T3.The results of ROC curve analysis showed that a 9.2％ SVV threshold discriminated between responders and non-responders with a sensitivity of 61％ and a specificity of 50％,and the area under the curve （95％ confidence interval） was 0.567 （0.378-0.757）.Conclusion SVV is not a suitable index in monitoring the changes in blood volume during laparoscopic surgery.

关 键 词：每搏输出量 血容量不足 监测 手术中 气腹 人工 

分 类 号：R614[医药卫生—麻醉学]