下腔静脉直径与全身麻醉患者脉压差变异率的相关性  

The Correlation between Inferior Vena Cava Diameter and Pulse Pressure Variation Rate in Patients Undergoing General Anesthesia

作　　者：薛瑶 卢星[1] 夏燕飞[1] XUE Yao;LU Xing;XIA Yan-fei(Zhejiang Hospital,Zhejiang 310013,China)

机构地区：[1]浙江医院麻醉科

出　　处：《心脑血管病防治》2019年第6期494-496,516,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：浙江省自然科学基金(编号:LY15H150005);浙江省医药卫生科技项目(编号:2015KYA002);浙江省中医药优秀青年人才基金项目(编号:2015ZQ001)

摘　　要：目的评估经腹超声测量下腔静脉(IVC)内径用于判断全身麻醉患者容量状态的准确性。方法选择择期在全身麻醉下手术的患者40例,有反应组11例,无反应组29例。在全麻诱导后予500mL乳酸林格液在30分钟内静脉滴注扩容,分别经腹超声测量全麻前、扩容前、扩容后的IVC内径最大值(IVCmax)、最小值(IVCmin)和下腔静脉呼吸塌陷指数(IVC-CI),同时记录经有创动脉监测获得的脉压差变异率(PPV),将扩容前PPV≥13%定义为有容量反应性,PPV <13%定义为无容量反应性。将IVC内径与PPV进行相关性分析,同时绘制受试者工作特征曲线(ROC曲线),评估IVC内径对容量反应的价值。结果全麻前、扩容前及扩容后IVC-CI与扩容前PPV正相关(r=0.38、0.51、0.50,P=0.02、0.00、0.00);扩容前及扩容后IVCmin与扩容前PPV负相关(r=-0.52、-0.47,P=0.00、0.00);全麻前、扩容前及扩容后IVCmax与扩容前PPV无相关(r=0.03、-0.11、-0.05,均P>0.05)。IVCmax、IVCmin及IVC-CI的ROC曲线下面积分别为0.44、0.21、0.75,IVC-CI预测PPV≥13%的界值为0.29(敏感度82%,特异度72%)。结论经腹超声测量IVCmin及IVC-CI可用于全身麻醉患者快速无创的容量评估。Objective To assess the veracity of inferior vena cava(IVC) diameter obtained with transabdominal ultrasound on estimate volume status in patients undergoing general anesthesia.Methods Forty patients scheduled for elective surgery were enrolled in our study.There were 11 cases in the responders group and 29 cases in the non-responders group.After anesthesia induction,lactated Ringer’s solution 500 m L was administered to patients as an intravenous(IV) fluid.The IVC diameters were measured with ultrasonography.The IVC maximum diameter(IVCmax),IVC minimum value(IVCmin),collapsibillity index of the inferior vena cava(IVC-CI) were collected before anesthesia induction,before and after fluid challenge.Pulse pressure variation(PPV) were obtained from the Mindray Bene View monitor.Patients were classified as responders if PPV increased ≥13% before fluid challenge,and non-responders if < 13%.Correlation analysis was used between IVC diameter and PPV.Meanwhile,the receiver operating characteristic curve(ROC curve) was drawn to evaluate the value of IVC diameter to volume response.Results IVC-CI before anesthesia induction,before and after fluid challenge were positively correlated with PPV before fluid challenge(r=0.38、0.51、0.50,P=0.02、0.00、0.00).IVCmin before anesthesia induction,before and after fluid challenge were negatively correlated with PPV before fluid challenge(r =-0.28、-0.52、-0.47,P=0.08、0.00、0.00).The IVCmax had no correlation with PPV before fluid challenge(r=0.03,-0.11、-0.05,P>0.05).The area under ROC curve(AUC) of IVCmax,IVCmin and IVC-CI were 0.44,0.21,0.75.When the cut-off value of IVC-CI was 0.29 for PPV≥13%,the sensitivity was 82% and the specificity was 72%.Conclusions Transabdominal ultrasound measurements of IVCmin and IVC-CI could fast and noninvasive assess volume status in patients undergoing general anesthesia.

关 键 词：容量反应性 下腔静脉内径 经腹超声 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.6[医药卫生—诊断学]