颈动脉峰值流速变异率评估腹腔镜手术患者容量反应性的价值  

Vadilidation of respirophasic variation in carotid artery blood flow peak velocity as predictors of fluid responsiveness in patients undergoing laparoscopic surgery

作　　者：王骁颖 张扬 高巨 彭艺 黄天丰 王存金 WANG Xiaoying , ZHANG Yang , GAO Ju , PENG Yi, HUANG Tianfeng, WANG Cunjin.(Department of Anesthesiology, Clinical Medical School of Yangzhou University, Subei People＇ s Hospital of Jiangsu Province, Yangzhou 225001, Chin)

机构地区：[1]扬州大学临床医学院,江苏省苏北人民医院麻醉科,扬州市225001

出　　处：《临床麻醉学杂志》2018年第2期109-113,共5页Journal of Clinical Anesthesiology

基　　金：江苏省青年医学重点人才项目(QNRC2016338)

摘　　要：目的探讨颈动脉峰值流速变异率(respirophasic variation in carotid artery blood flow peak velocity,ΔVpeak-CA)评估腹腔镜手术患者容量反应性的准确性和可行性。方法选择择期行腹腔镜下手术患者55例,男29例,女26例,年龄45~75岁,BMI 20~24 kg/m2,ASAⅠ~Ⅲ级。在气腹压稳定于13~15 mm Hg后,20 min内快速静脉输注羟乙基淀粉130/0.4氯化钠注射液7 ml/kg。以心脏指数(cardiac index,CI)的增长量(ΔCI)≥15%作为液体反应阳性的判定标准,分为有反应组(R组,n=32)和无反应组(NR组,n=23),并绘制ΔVpeak-CA判断容量变化的受试者工作特性曲线(receiver operating characteristic curve,ROC),计算诊断阈值、曲线下面积(area under curve,AUC)和95%可信区间(CI)。记录麻醉诱导后5 min(气腹前,T1)、气腹压上调稳定于13~15 mm Hg5 min后(T2)、补液后5 min(T3)的每博变异率(SVV)、ΔVpeak-CA和CI。结果气腹下补液前ΔVpeak-CA与CI呈高度负相关(r=-0.843,P<0.001)。ΔVpeak-CA评估容量反应性的ROC曲线的AUC为0.884(95%CI 0.793~0.975),诊断阈值为17.85%,判断液体反应性的灵敏度为81.3%,特异度为91.3%。结论ΔVpeak-CA可作为腹腔镜手术患者评估容量反应性的可靠指标。Objective To assess the accuracy and feasibility of respirophasic variation in carotid artery blood flow peak velocity （AVpeak-CA） as predictors of fluid responsiveness in laparoscopic surgery. Methods Fifty-five patients undergoing laparoscopic surgeries, 29 males and 26 females, aged 45-75 years, ASA physical statusⅠ-Ⅲ, with body mass index 20-24 kg/mz, were enrolled. When intra-abdominal pressure was steady at the level of 13-15 mm Hg, 6% hydroxyethylstarch （HES 130/0. 4） 500 ml was infused at the speed of 7 ml/kg within 20 minutes. After volume expan- sion, subjects were classified as responders （group R, n=32） if cardiac index increased （ACI） was≥15% and no responders （group NR, n = 23） as △CI〈15%. The receiver operating characteristic curve （ROC） curve for AVpeak-CA in determining the volume expansion responsiveness was plotted, and the diagnostic threshold was determined. The area under curve （AUC） and 95 % confidence inter- val （CI） was calculated. Cardiac index （CI）, AVpeak-CA and stroke volume variation （SVV） were independently recorded at 5 minutes after induction （T1）, 5 minutes after intra-abdominal pressure were stable at the level of 13-15 rnm Hg （T2） and 5 minutes after volume expansion （T3）. Results AVpeak-CA is highly negatively correlated with CI （r=-0. 843, P%0. 001）. The results of ROC curve analysis showed, AVpeak-CA threshold discriminated between responders and non-re- sponders with a sensitivity of 81.3% and a specificity of 91.3%, and the AUC was 0. 884 （95% CI 0. 793-0. 975）. Conclusion AVpeak-CA seems to be a highly feasible and reliable predictor for fluid responsiveness in laparoscopic surgery patients.

关 键 词：容量 腹腔镜 颈动脉峰值流速变异率 气腹压 心脏指数 

分 类 号：R614[医药卫生—麻醉学]