微量液体冲击试验判断俯卧位手术老年患者容量反应性的准确性  

Accuracy of mini-fluid challenge test in predicting fluid responsiveness in elderly patients undergoing surgery in prone position

作　　者：刘敏于 杨雪梅 范晓君 徐世元[1] 张鸿飞[1] Liu Minyu;Yang Xuemei;Fan Xiaojun;Xu Shiyuan;Zhang Hongfei(Department of Anesthesiology,Zhujiang Hospital of Southern Medical University,Guangzhou 510282,China;Department of Anesthesiology,Chongqing University Cancer Hospital,Chongqing 400030,China;Department of Anesthesiology,Guangdong Women and Children's Hospital,Guangzhou 511442,China)

机构地区：[1]南方医科大学珠江医院麻醉科,广州510282 [2]重庆大学附属肿瘤医院麻醉科,400030 [3]广东省妇幼保健院麻醉科,广州511442

出　　处：《中华麻醉学杂志》2021年第12期1498-1501,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价微量液体冲击试验判断俯卧位手术老年患者容量反应性的准确性。方法择期行脊柱外科手术老年患者48例,年龄≥65岁,BMI 18~30 kg/m^(2),ASA分级Ⅱ或Ⅲ级。术中采用容量控制模式通气,设置V_(T) 6 ml/kg。行桡动脉穿刺置管术,连接FloTrac/Vigileo监测系统监测血流动力学参数。俯卧位后5 min,待患者血流动力学稳定,开始容量负荷试验:经1 min静脉输注乳酸钠林格液1 ml/kg,1 min后再经1 min静脉输注乳酸钠林格液1 ml/kg,1 min后再经5 min静脉输注乳酸钠林格液3 ml/kg,1 min后开始手术。分别于气管插管后俯卧位前(T_(1))、俯卧位5 min(T_(2))、第1次输注1 ml/kg液体后1 min(T_(3))、第2次输注1 ml/kg液体后1 min(T_(4))和输注3 ml/kg液体后1 min(T_(5))时,记录HR、MAP、CO、CI、SV、每搏量指数(SVI)、每搏量变异度(SVV)、脉压变异度(PPV),计算ΔSVI_(1 ml/kg)、ΔSVI_(2 ml/kg)和ΔSVI5 ml/kg。以ΔSVI5 ml/kg≥10%为容量负荷试验阳性,分为有容量反应组(R组)和无容量反应组(NR组)。绘制ΔSVI_(1 ml/kg)、ΔSVI_(2 ml/kg)、SVV和PPV判断患者容量反应性的受试者工作特征曲线,并计算曲线下面积(AUC)。结果R组30例,NR组18例。ΔSVI_(1 ml/kg)判断患者容量反应性的AUC为0.87,诊断阈值为7%,灵敏度为80%,特异度为83%。ΔSVI_(2 ml/kg)判断患者容量反应性的AUC为0.928,诊断阈值为8%,灵敏度为78%,特异度为89%。SVV、PPV判断患者容量反应性的AUC分别为0.65、0.53。结论以ΔSVI指导的微量液体冲击试验可准确地判断俯卧位手术老年患者的容量反应性,且快速输注2 ml/kg晶体液的准确性优于1 ml/kg。Objective To evaluate the accuracy of mini-fluid challenge test in predicting fluid responsiveness in elderly patients undergoing surgery in prone position.Methods Forty-eight elderly patients,aged≥65 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for elective spinal surgery,were enrolled.Patients were mechanically ventilated using a volume-controlled mode with a tidal volume of 6 ml/kg of ideal body weight during operation.A radial arterial catheter was inserted and connected to FloTrac/Vigileo system to monitor hemodynamic parameters.At 5 min after prone position,volume expansion was started when the hemodynamics was stable:lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min,1 min later lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min,1 min later lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min,and 1 min later operation was started.After tracheal intubation and before prone position(T_(1)),5 min of prone position(T_(2)),1 min after 1st infusion of 1 ml/kg liquid(T_(3)),and 1 min after 2nd infusion of 1 ml/kg liquid(T_(4))and 1 min after infusion of 3 ml/kg fluid(T_(5)),heart rate,mean arterial pressure,cardiac output,cardiac index,stroke volume,stroke volume index(SVI),stroke volume variability(SVV),pulse pressure variability(PPV),and changes in SVI induced by rapid infusion of 1,2 and 5 ml/kg crystalloid(ΔSVI_(1 ml/kg),ΔSVI_(2 ml/kg),ΔSVI5 ml/kg)were calculated.Positive fluid challenges were defined as an increase in SVI of 10%or more from baseline,and the patients were divided into responder group(R)and non-responder group(NR).Receiver operating characteristic curves predicting fluid responsiveness were generated forΔSVI_(1 ml/kg),ΔSVI_(2 ml/kg),SVV and PPV,and areas under the receiver operating characteristic curves(AUC)were calculated.Results Thirty patients were enrolled in group R and 18 cases in group NR.The AUC ofΔSVI_(1 ml/kg) in predicting fluid volume resp

关 键 词：补液疗法 血管容量 老年人 俯卧位 

分 类 号：R614[医药卫生—麻醉学]