每搏输出量变异度和下腔静脉扩张指数预测全肺切除术后容量反应性的比较研究  

Comparative study of stroke volumevariation and distensibility index of inferior vena cavain predicting volume response after pneumonectomy

作　　者：王研[1,2] 张劲松[1] 杜成[2] 

机构地区：[1]南京医科大学第一附属医院急诊中心,南京210029 [2]南京市胸科医院重症医学科

出　　处：《临床急诊杂志》2017年第8期576-578,582,共4页Journal of Clinical Emergency

基　　金：南京市卫计委科技基金(No:YKK14133)

摘　　要：目的:比较每搏输出量变异度(SVV)和下腔静脉扩张指数(dIVC)预测全肺切除术后患者容量变化的准确性。方法:收集2014-08-2017-04我院重症医学科收治的18例全肺切除术后机械通气下需行血流动力学监测的患者,统一采用脉搏指示连续心输出量监测仪(PICCO)监测SVV,同时应用超声测量dIVC。记录补液试验前基线血流动力学参数和补液试验(7ml/kg的羟乙基淀粉)后的血流动力学参数。以CI变化量(△CI)>15%为容量治疗有反应性,将患者分为有反应组和无反应组。分别绘制SVV和dIVC的受试者工作曲线(ROC),计算曲线下面积(AUC)。结果:CVP、SVV、dIVC预测全肺切除术后机械通气患者容量反应性的AUC分别为0.604,0.893和0.863,CVP预测容量反应性无统计学意义,SVV、dIVC预测容量反应性有统计学意义(P<0.05)。结论:SVV和dIVC均是全肺切除术后行机械通气患者的容量反应性评估的可靠参数,两者均有重要的临床意义,值得推广。Objective：To compare the accuracy of stroke volume variation（SVV）and distensibility index of inferior vena cava（dIVC）on blood volume status after total pneumonectomy.Method：We collected 18 patients who underwent hemodynamic monitoring after surgerywith mechanical ventilation from August 2014 to April 2017 in ICU.Pulse indicator continuous cardiac output monitor（PICCO）was used for monitoring SVV for all the patients and bedside ultrasound was performed to identify dIVC at the same time.The hemodynamic parameters of the baseline and the rehydration test（7ml/kg of hydroxyethyl starch）were recorded.Reaction group and no response group were marked according to△CI greater than 15%.ROC curve of the SVV and dIVC were analyzed respectively.Result：Prediction of the CVP,SVV and dIVC in capacity reactive AUC were 0.604,0.893 and 0.863 in patients with mechanical ventilation after pneumonectomy.Prediction of the CVP in capacity reactive was no statistical significance.Prediction of the SVV,dIVC were statistically significant（P〈0.05）.Conclusion：SVV and dIVC are reliable and important parameters to evaluate the capacity reactivity after pneumonectomy.

关 键 词：每搏输出量变异度 下腔静脉扩张指数 超声 容量反应性 

分 类 号：R459.7[医药卫生—急诊医学]