小剂量容量负荷试验下血细胞比容下降率对患者容量状态评估的准确性  

Accuracy of hematocrit decline rate in evaluating volume status based on low-dose volume-loading test in patients receiving general anesthesia

作　　者：李妍 张志梅[2] 赵亚娟 王伟芝[2] 罗艳华[2] LI Yan;ZHANG Zhimei;ZHAO Yajuan;WANG Weizhi;LUO Yanhua(Faculty of Anesthesiology,Weifang Medical University,Weifang 261053,Shandong,China;不详)

机构地区：[1]潍坊医学院麻醉学院,山东潍坊261053 [2]潍坊市人民医院麻醉科

出　　处：《上海医学》2022年第5期349-352,共4页Shanghai Medical Journal

摘　　要：目的探讨小剂量(2 mL/kg)容量负荷试验下血细胞比容(hematocrit,HCT)的下降率对患者全身麻醉(简称全麻)诱导前容量状态评估的准确性和诊断阈值。方法选择2020年12月—2021年3月于潍坊市人民医院行腹腔镜下胃癌根治术的患者40例,ASA分级Ⅰ或Ⅱ级。全麻诱导前,1 min内快速静脉输注羟乙基淀粉130/0.4氯化钠注射液2 mL/kg。根据全麻诱导循环稳定后每搏变异度(strok volume variability,SVV)分为两组:SVV>13%为容量不足组(22例),SVV≤13%为容量正常组(18例)。记录小剂量容量负荷试验前3 min(T_(1))、小剂量容量负荷试验后3 min(T_(2))、全麻诱导后3 min(T_(3))时心率、平均动脉压、心脏指数(CI),记录T_(3)时SVV,记录T_(1)、T_(2)时HCT,计算并绘制血细胞比容下降率(hematocrit decline rate,ΔHCT)判断容量状态的ROC曲线,计算诊断阈值、AUC和95%CI。结果与T_(1)时间点比较,两组患者T_(2)时间点的CI值均显著升高(P值均<0.05),而心率、MAP的差异无统计学意义(P值均>0.05)。与同组T_(2)时间点比较,两组患者T_(3)时间点的CI、心率、MAP均显著下降(P值均<0.05)。T_(2)时容量不足组ΔHCT显著高于容量正常组(P<0.05),T_(3)时容量不足组SVV高于容量正常组(P<0.05),T_(3)时容量不足组CI显著低于容量正常组(P<0.05)。T_(1)、T_(2)时间点两组心率、MAP的差异均无统计学意义(P值均>0.05)。通过小剂量(2 mL/kg)容量负荷试验得到的ΔHCT评估患者容量状态的ROC曲线的AUC为0.950(95%CI为0.859~1.000),诊断阈值为8.4%,判断容量状态的灵敏度为0.9,特异度为1.0。结论小剂量(2 mL/kg)容量负荷试验下的ΔHCT可作为评估患者全麻诱导前容量状态的可靠指标。Objective To explore the role of hematocrit decline rate(ΔHCT)under low-dose(2 mL/kg)volume-loading test in evaluation of the accuracy and the cutoff value of volume status before general anesthesia induction.Methods Forty patients with gastric cancer who were in ASA gradeⅠorⅡand underwent laparoscopic radical gastrectomy from December 2020 to March 2021 in Weifang People’s Hospital were selected.Before induction of anesthesia,hydroxyethyl starch 130/0.4 sodium chloride injection 2 mL/kg was given intravenously within 1 min.According to the stroke volume variability(SVV)after induction,the patients were divided into hypovolemic group(SVV>13%,n=22)and non-hypovolemic group(SVV≤13%,n=18).Heart rate(HR),mean arterial pressure(MAP)and cardiac index(CI)were recorded at 3 min before low-dose volume-loading test(T_(1)),3 min after the test(T_(2)),and 3 min after induction of anesthesia(T_(3)).SVV was recorded at T_(3).The hematocrit was recorded at T_(1) and T_(2).The ROC curve ofΔHCT was drawn to calculate the cutoff value,area under curve(AUC)and 95%CI.Results Compared with T_(1),the CI of two groups increased at T_(2)(both P<0.05),but there was no significant difference in HR and MAP(all P>0.05).Compared with T_(2),CI,HR and MAP in two groups decreased at T_(3)(all P<0.05).ΔHCT in hypovolemic group was higher than that in non-hypovolemic group at T_(2)(P<0.05).SVV in hypovolemic group was higher than that in non-hypovolemic group at T_(3)(P<0.05),and CI in hypovolemic group was lower than that in non-hypovolemic group at T_(3)(P<0.05).There was no significant difference in HR and MAP between the two groups at T_(1) and T_(2)(all P>0.05).The result of ROC curve analysis showed that the AUC of theΔHCT to assess the patient’s volume state by low-dose volume-loading test was 0.95(95%CI:0.859-1.000),the cutoff value was 8.4%,the sensitivity to judge the volume state was 90%,and the specificity was 100%.ConclusionΔHCT based on low-dose(2 mL/kg)volume-loading test seems to be a highly feasible and reliable pr

关 键 词：容量 血细胞比容 每搏量变异度 

分 类 号：R614[医药卫生—麻醉学] R735.2[医药卫生—外科学]