肺复张联合肱动脉峰流速变异度预测患者术中容量反应性的准确性  

Accuracy of lung recruitment maneuver combined with brachial artery peak velocity variation in predicting fluid responsiveness

作　　者：瞿敏[1] 姚忠岩[1] 刘天琳 李婧 王娟[1] 闫宁[1] 杨强[1] 刘明远[1] Qu Min;Yao Zhongyan;Liu Tianlin;Li Jing;Wang Juan;Yan Ning;Yang Qiang;Liu Mingyuan(Department of Anesthesiology,Cangzhou Center Hospital,Cangzhou 061001,China;Department of Ultrasonography,Cangzhou Center Hospital,Cangzhou 061001,China)

机构地区：[1]沧州市中心医院麻醉科,061001 [2]沧州市中心医院超声科,061001

出　　处：《中华麻醉学杂志》2020年第2期217-220,共4页Chinese Journal of Anesthesiology

基　　金：沧州市重点研发计划指导项目(183302045)。

摘　　要：目的评价肺复张联合肱动脉峰流速变异度(ΔVp)预测患者术中容量反应性的准确性。方法择期全麻下行开腹胃肠手术患者64例,年龄18~64岁,性别不限,BMI 19~26 kg/m2,ASA分级Ⅰ或Ⅱ级,NYHA分级Ⅰ或Ⅱ级。麻醉诱导后依次进行肺复张(保持30 cmH2O气道正压10 s)和容量负荷试验。于肺复张开始时采用超声测量ΔVp。于肺复张前(T1)、肺复张时(T2)、容量负荷前(T3)、容量负荷后(T4)记录MAP、HR、CVP、SV,计算各指标肺复张前后变化率(ΔMAPLRM、ΔHRLRM、ΔCVPLRM、ΔSVLRM)和容量负荷试验前后变化率(ΔMAPVE、ΔHRVE、ΔCVPVE、ΔSVVE)。以ΔSVVE≥15%定义容量负荷试验阳性,分为有反应组(≥15%,R组)和无反应组(【15%,NR组)。结果 R组34例,NR组30例。与NR组比较,R组T2时MAP和T1,2时SV降低,ΔMAPLRM、ΔMAPVE、ΔSVLRM和ΔSVVE升高,ΔVp升高(P<0.05)。ΔVp与ΔSVVE呈正相关(r=0.829,P【0.05),ΔSVLRM与ΔSVVE呈负相关(r=-0.876,P【0.05),ΔVp与ΔSVLRM呈负相关(r=-0.819,P【0.05)。肺复张联合ΔVp预测患者容量反应性的受试者工作特征曲线下面积为0.808,诊断阈值32.3%,灵敏度75.3%,特异度88.2%。结论肺复张联合ΔVp(≥32.3%)可准确预测患者术中容量反应性。Objective To evaluate the accuracy of lung recruitment maneuver(LRM)combined with brachial artery peak velocity variation(ΔVp)in predicting fluid responsiveness.Methods Sixty-four patients of both sexes,aged 18-64 yr,with body mass index 19-26 kg/m2,of American Society of Anesthesiologists physical statusⅠorⅡ,with New York Heart Association classⅠorⅡ,scheduled for elective open gastrointestinal surgery under general anesthesia,were enrolled in this study.LRM(positive airway pressure was maintained at 30 cmH2O for 10 s)and volume loading test were performed in sequence after anesthesia induction.ΔVp was measured by ultrasonography at the beginning of LRM.Mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP)and stroke volume(SV)were recorded before LRM(T1),during LRM(T2),before volume expansion(T3)and after volume expansion(T4).The changing rate of each index before and after LRM(ΔMAPLRM,ΔHRLRM,ΔCVPLRM,ΔSVLRM)and before and after volume expansion(ΔMAPVE,ΔHRVE,ΔCVPVE,ΔSVVE)were calculated.ΔSVVE≥15%was considered to be a positive response after volume expansion,and patients were divided into response group(≥15%,R group)and non-response group(<15%,NR group).Results There were 34 cases in R group and 30 cases in NR group.Compared with NR group,MAP at T2 and SV at T1,2 were significantly decreased,ΔMAPLRM,ΔMAPVE,ΔSVLRM andΔSVVE were increased,andΔVp was increased in group R(P<0.05).There was a positive correlation betweenΔVp andΔSVVE(r=0.829,P<0.05),a negative correlation betweenΔSVLRM andΔSVVE(r=-0.876,P<0.05),and a negative correlation betweenΔVp andΔSVLRM(r=-0.819,P<0.05).The area under the receiver operating characteristic curve of LRM combined withΔVp was 0.808,and the cut-off value was 32.3%,the sensitivity 75.3%,and the specificity 88.2%.Conclusion LRM combined withΔVp(≥32.3%)can accurately predict the intraoperative fluid responsiveness in patients.

关 键 词：正压通气 血管容量 肱动脉 血流速度 

分 类 号：R614[医药卫生—麻醉学]