呼气末正压抬高期间肱动脉峰流速差值对患者术中容量反应性的预测作用  

Predictive effect of brachial artery peak velocity difference during positive end-expiratory pressure elevation on intraoperative fluid responsiveness

作　　者：瞿敏[1] 刘天琳 姚忠岩[1] 李婧 杨强[1] 王娟[1] 刘明远[1] 闫宁[1] QU Min;LIU Tianlin;YAO Zhongyan;LI Jing;YANG Qiang;WANG Juan;LIU Mingyuan;YAN Ning(Department of Anesthesiology,Cangzhou Center Hospital,Cangzhou 061001,China)

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

出　　处：《临床麻醉学杂志》2020年第8期750-753,共4页Journal of Clinical Anesthesiology

摘　　要：目的评估呼气末正压(PEEP)抬高期间肱动脉峰流速差值对患者术中容量反应性的预测作用。方法择期全麻下行胃肠手术患者67例,男45例,女22例,年龄40~72岁,BMI 18~25 kg/m2,ASAⅠ或Ⅱ级,心功能Ⅰ或Ⅱ级。麻醉诱导后所有患者均先后进行PEEP抬高试验和容量负荷试验。将扩容后每搏量增加≥15%的患者纳入有反应组(R组,n=35),扩容后每搏量增加<15%的患者纳入无反应组(NR组,n=32)。分别在PEEP抬高前、PEEP抬高时记录HR、MAP、中心静脉压(CVP)、每搏量(SV),同时超声测量肱动脉峰流速记录肱动脉峰流速最大值(Vpmax)、肱动脉峰流速最小值(Vpmin)、肱动脉峰流速变异度(ΔVp),计算上述指标的差值(Δ)。采用受试者工作特征曲线(ROC曲线)评估ΔVpmin、ΔΔVp预测容量反应性的效能。结果 PEEP抬高期间R组ΔVpmin、ΔΔVp明显高于NR组(P<0.05)。ΔVpmin、ΔΔVp预测容量反应性的ROC曲线下面积(AUC)分别为0.887(95%CI 0.808~0.965)和0.817(95%CI 0.710~0.924)。讨论 PEEP抬高期间肱动脉峰流速差值可有效预测术中容量反应性,其中ΔVpmin有较好的预测作用。Objective To evaluate the predictive effect of peak brachial artery velocity difference during positive end-expiratory pressure(PEEP) elevation on intraoperative fluid responsiveness. Methods Sixty-seven patients, 45 males and 22 females, aged 40-72 years, with a BMI 18-25 kg/m2, ASA physical status Ⅰ or Ⅱ, cardiac function grade Ⅰ or Ⅱ, underwent gastrointestinal surgery under selective general anesthesia. After induction of anesthesia, all patients underwent PEEP elevation test and vo￣lumetric load test. Patients with a stroke volume(SV) increase ≥ 15% after volume expansion were included in the response group(group R, n = 35),and stroke volume increase <15% after volume expansion were included in the non-response group(group NR, n = 32). HR, MAP, CVP and SV were recorded before and during PEEP elevation, meanwhile, the peak velocity of brachial artery was measured using ultrasound, the maximum value of brachial artery flow velocity(Vpmax), the minimum value of brachial artery flow velocity(Vpmin) and the variation of peak brachial flow velocity(ΔVp) were recorded, the difference(Δ) of the above indicators was calculated. The receiver operating characteristic(ROC) curve was used to evaluate the predictive value of ΔVpmin, ΔΔVp for predicting fluid responsiveness. Results ΔVpmin and ΔΔVp in group R were significantly higher than those in group NR during the elevation of PEEP(P < 0.05). The area under curve(AUC) for predicting volume responsiveness by ΔVpmin and ΔΔVp was 0.887(95%CI 0.808-0.965) and 0.817(95%CI 0.710-0.924), respectively. Conclusion Peak flow velocity difference of brachial artery during PEEP elevation can effectively predict fluid responsiveness of patients during operation. Among them, ΔVpmin has a better predictive effect.

关 键 词：呼气末正压 超声测量 容量反应性 肱动脉峰流速 

分 类 号：R614[医药卫生—麻醉学]