脉压变异度和每搏量变异度变化值预测PCV-VG模式下患者容量反应性的准确性  

Accuracy of changes in pulse pressure variation and stroke volume variation in predicting fluid responsiveness in patients ventilated in PCV-VG mode

作　　者：蒋钰 蒋玲玲[1] 胡军[1] 李锐[1] 张野[1] Jiang Yu;Jiang Lingling;Hu Jun;Li Rui;Zhang Ye(Department of Anesthesiology and Perioperative Medicine,Second Hospital of Anhui Meidical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院麻醉与围术期医学科,合肥230601

出　　处：《中华麻醉学杂志》2020年第9期1129-1131,共3页Chinese Journal of Anesthesiology

基　　金：安徽省科技攻关项目(1704a0802165)。

摘　　要：目的评价脉压变异度变化值(ΔPPV)和每搏量变异度变化值(ΔSVV)预测压力控制容量保证通气(PCV-VG)模式下患者容量反应性的准确性。方法择期全身麻醉下行胃肠肿瘤手术患者60例,性别不限,年龄18~64岁,BMI 18.5~23.9 kg/m2,ASA分级Ⅰ或Ⅱ级,麻醉诱导后手术开始前,采用PCV-VG模式进行机械通气,监测VT 6 ml/kg时脉压变异度(PPV6)和每搏量变异度(SVV6)。然后进行VT负荷试验(TVC),即将VT由6 ml/kg增加至8 ml/kg,维持1 min后监测VT 8 ml/kg时PPV8和SVV8。计算TVC前后PPV和SVV变化值(ΔPPV和ΔSVV)。完成TVC后将VT调回6 ml/kg进行补液试验,以补液后CI增加幅度≥15%为容量反应阳性标准,绘制各指标预测患者容量反应性的受试者工作特征(ROC)曲线。结果PPV6、SVV6、PPV8、SVV8、ΔPPV和ΔSVV预测患者容量反应性的ROC曲线下面积(95%置信区间)分别为0.57(0.43~0.72)、0.62(0.47~0.76)、0.83(0.73~0.87)、0.76(0.64~0.88)、0.95(0.90~1.00)和0.91(0.86~0.99);PPV8、SVV8、ΔPPV和ΔSVV的诊断临界值分别为10.5%、13.5%、4.5%和5.5%;灵敏度分别为75%、78%、88%和85%;特异度分别为88%、87%、95%和98%。结论PCV-VG模式下,ΔPPV和ΔSVV均可准确预测患者容量反应性。Objective To evaluate the accuracy of changes in pulse pressure variation(ΔPPV)and changes in stroke volume variation(ΔSVV)in predicting fluid responsiveness in the patients ventilated in pressure-controlled ventilation-volume guaranteed(PCV-VG)mode.Methods Sixty patients of both sexes,aged 18-64 yr,with body mass index of 18.5-23.9 kg/m2,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective resection of gastrointestinal tumor with general anesthesia,were enrolled in the study.After intravenous anesthesia induction and before the start of the surgery,the patients were ventilated in PCV-VG mode with tidal volume(VT)6 ml/kg,and the PPV6 and SVV6 were recorded.TVC was then performed,VT was increased from 6 ml/kg to 8 ml/kg and maintained at this level for 1 min,and PPV8 and SVV8 were then monitored and recorded.TheΔPPV andΔSVV were calculated before and after TVC.When TVC was completed,the VT was adjusted back to 6 ml/kg for fluid replacement test.Increase in cardiac index after fluid replacement test≥15%was considered to be a positive response.The receiver operating characteristic curve for each indicator in predicting fluid responsiveness was drawn.Results The results of receiver operating characteristic curve analysis showed that the area under the curve for PPV6,SVV6,PPV8,SVV8,ΔPPV andΔSVV in predicting fluid responsiveness(95%confidence interval)was 0.57(0.43-0.72),0.62(0.47-0.76),0.83(0.73-0.87),0.76(0.64-0.88),0.95(0.90-1.00)and 0.91(0.86-0.99),respectively,the cutoff value of PPV8,SVV8,ΔPPV andΔSVV was 10.5%,13.5%,4.5%and 5.5%,respectively,the sensitivity was 75%,78%,88%and 85%,respectively,and the specificity was 88%,87%,95%and 98%,respectively.ConclusionΔPPV andΔSVV can accurately predict fluid responsiveness in the patients ventilated in PCV-VG mode.

关 键 词：每搏输出量 血压 血量 

分 类 号：R614[医药卫生—麻醉学]