每搏输出量变异评估腹腔高压家猪液体反应性的有效性  

Validity of stroke volume variation for predicting fluid responsiveness in different grades of intra-abdominal pressure

作　　者：祁慧[1] 顾勤[1] 刘宁[1] 徐颖[1] 张北源[1] 韩云宏[1] 

机构地区：[1]南京大学医学院附属鼓楼医院重症医学科,210093

出　　处：《临床麻醉学杂志》2017年第8期805-807,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨每搏输出量变异(SVV)评价不同腹腔高压家猪液体反应性的有效性。方法选择实验家猪40只,经颈动脉释放家猪30%血容量,维持家猪低血容量状态,并按随机数字表法随机分为四组,采用氮气气腹法分别维持腹腔压力(IAP)为0 mm Hg(L0组)、15 mm Hg(L15组)、25mm Hg(L25组)和35mm Hg(L35组),稳定30min后给予HES 500 ml液体复苏,采用脉搏轮廓持续心输出量监测(PiCCO)法分别于基线水平、低血容量模型建立后、液体复苏后测家猪SVV以及液体复苏前后每搏输出量(SV)。结果 L0组和L15组家猪SVV与SV呈明显正相关(r分别为0.888和0.942,P<0.05),而L25组和L35组SVV与SV均无明显相关性(r分别为0.068和-0.114)。结论 IAP轻度升高(IAP≤15mm Hg)时,SVV可作为评估液体反应性的有效指标,重度腹腔高压(IAP≥25mm Hg)时,SVV不能有效评估液体反应性。Objective To evaluate the validity of stroke volume variation（SVV）for predicting fluid responsiveness in different grades of intra-abdominal pressure（IAP）.Methods Forty pigs were involved in the study.Hypovolemia was made by blood withdraw of 30% of estimated blood volume from each animal via carotid artery.All the pigs were randomized into four groups namly 0 mm Hg（L0）,15 mm Hg（L15）,25 mm Hg（L25）and 35 mm Hg（L35）.Nitrogen was inflated slowly till IAP to 0,15,25 and 35mm Hg.Fluid loading was performed with 500 ml hydroxyethyl starch within 30 minutes.Hemodynamic parameters were evaluated by the thermodilution technique of pulse induced continuous cardiac output（PiCCO）.SVV and stroke volume（SV）were measured before and after fluid loading.Results In groups L0 and L15,SVV was positive correlated with changes in SV（r=0.888,0.942,respectively,P〈0.05）.In groups L25 and L35,there were poor correlations between SVV and changes in SV（r=0.068,-0.114,respectively）.Conclusion When IAP was slightly increased up to 15 mm Hg, SVV remains an effectiveness index to predict fluid responsiveness index,however it failed to assess fluid responsiveness effectively when IAP is further raised up to 25 mm Hg or more.

关 键 词：腹腔高压 每搏输出量变异 液体反应性 心输出量 

分 类 号：R459.7[医药卫生—急诊医学]