每搏量变异度指导肝移植手术液体治疗诊断阈值的探讨  

Diagnostic kit of stroke volume variation in the assessment of volume expansion responses in patients undergoing liver transplantation

作　　者：董兰[1] 安丽娜[1] 刘多辉[1] 李占军[1] 蔡俊刚[1] 谭殿学 陈晓阳[1] 韩曙君[1] 

机构地区：[1]武警总医院麻醉科,北京100039

出　　处：《武警医学》2016年第6期593-596,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的分析每搏量变异度（SVV）监测肝移植手术患者血容量变化的准确性,探讨其指导液体治疗的诊断阈值。方法随机选择肝移植手术患者88例,根据终末期肝病模型（MELD）评分,将患者分为A、B和C组,MELD分值〈15分为A组,15~24分为B组,≥25分为C组,所有患者均采用Flotrac/Vigileo系统监测心指数（CI）和每搏量变异度（SVV）等指标。所有患者均于麻醉后手术开始前以0.4 ml/（kg·min）的速率静脉输注6%羟乙基淀粉8 ml/kg,于液体治疗即刻和液体治疗后3 min,记录中心静脉压（CVP）、CI和SVV等血流动力学参数,计算CVP、SVV和CI的变化率（ΔCVP、ΔSVV和ΔCI）。并以ΔCI≥15%为扩容有效标准,各组分别绘制CVP和SVV监测血容量变化的受试者工作特性曲线（ROC）,计算曲线下面积（AUC）和诊断阈值。结果 ROC曲线提示,3组患者SVV监测血容量变化的AUC为0.855,0.857和0.867,诊断准确性较好,而CVP的诊断性不高;MELD低于15分,SVV指导液体治疗的诊断阈值为11.5%,MELD高于15分时,其诊断阈值为10.5%。结论 SVV监测肝移植手术患者血容量变化的准确度较好,但应该根据MELD评分选择不同的诊断阈值,以指导液体治疗。Objective To approach the effectiveness and diagnostic kit of stroke volume variation（SVV） in assessment of vol- ume expansion responses in patients undergoing liver transplantation （LV）. Methods 88 patients undergoing LV were selected ran- domly, and divided into three groups according to model for end-stage liver disease （MELD）. Continuous monitoring for cardiac output was performed by arterial pressure waveform cardiac output （APCO） and mechanical ventilation （VT 8 ml/kg, respiratory rate 10-14 bpm, PEEP 〈 10 cmH2O） was selected after intubation. Fluid therapy of 6% hydroxyethyl starch 130/0.4 8 ml/kg was infused at a rate of 0.4 ml/（ kg · min）. Following data, including central venous pressure （CVP） , cardiac index（CI） , SVV and other hemody- namic parameters, were recorded before and after fluid therapy. ACI 15% was taken as the criterion of volume expansion. The chan- ging rate of CVP（ACVP） , SVV（ASVV） or CI（ACI） was calculated. Statistical analysis of the related parameters was performed. Results Receiver operating characteristic curve （ROC） results showed that the areas under the ROC curve（AUC） for SVV were be- tween 0.8 and 0.9 in the three groups, which were O. 855, 0. 857 and 0. 867, indicating that the discriminative power of SVV was credible. Moreover, the diagnostic kit was 11. 5% when MELD was lower than 15, and 10. 5% when it was higher than 15. Conclusions SVV is effective and helpful in assessment of volume expansion response, and it is diagnostic kit is 11.5% or 10.5% according to MELD.

关 键 词：每搏量变异度 肝移植手术 FloTrac/Vigileo监测系统 液体治疗 MELD评分 诊断阈值 

分 类 号：R614.2[医药卫生—麻醉学]