潮气量负荷试验评估单肺通气患者容量反应性  

Tidal volume challenge evaluate fluid responsiveness during one-lung ventilation

作　　者：张嘉桐 张扬 杨柳青 孙思阳 高巨 ZHANG Jiatong;ZHANG Yang;YANG Liuqing;SUN Siyang;GAO Ju(Department of Anesthesiology,Clinical Medical School of Yangzhou University,Northern Jiangsu People's Hospital,Yangzhou 225001,China)

机构地区：[1]扬州大学临床医学院江苏省苏北人民医院麻醉科,225001

出　　处：《临床麻醉学杂志》2022年第7期677-681,共5页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(82172190);江苏省卫生健康委员会医学科研项目面上项目(M2021105)。

摘　　要：目的探讨潮气量负荷试验(V_(T)C)时的血流动力学变化在评估单肺通气(OLV)容量反应性中的价值。方法选择择期全身麻醉下行胸腔镜手术患者58例,男25例,女33例,年龄18~64岁,BMI 18~25 kg/m^(2),ASAⅠ—Ⅲ级。记录OLV 15 min时(V_(T)C前)、V_(T)C后2 min(V_(T)C后)、V_(T)调回5 ml/kg后2 min[容量负荷试验(VLT)前]和VLT后HR、MAP,应用经食管超声心动图(TEE)测量并记录上述4个时点的食管中段切面左心室流出道(LVOT)直径、胃底长轴切面主动脉瓣速度时间积分(VTI)和每搏量(SV),并计算V_(T)C前后SV相对变化率(ΔSV-V_(T)C)、V_(T)C前后VTI相对变化率(ΔVTI-V_(T)C)、V_(T)C前后MAP相对变化率(ΔMAP-V_(T)C)和VLT前后SV相对变化率(ΔSV-VLT)。根据ΔSV-VLT将患者分为两组:容量反应性阳性组(R组,ΔSV-VLT≥10%)和容量反应性阴性组(NR组,ΔSV-VLT<10%)。绘制各指标的受试者工作特征(ROC)曲线,计算曲线下面积(AUC)评估患者容量反应性。结果最终32例(55%)患者容量反应性阳性。ΔSV-V_(T)C的AUC为0.81(95%CI 0.68~0.90),诊断界值为-16.1%,敏感性、特异性分别为78.1%、84.6%。ΔVTI-V_(T)C的AUC为0.79(95%CI 0.66~0.89),诊断界值为-14.5%,敏感性、特异性分别为78.1%、80.8%。ΔMAP-V_(T)C的AUC为0.56(95%CI 0.42~0.69),诊断界值为-5.1%,敏感性、特异性分别为53.1%、65.4%。结论潮气量负荷试验诱导的SV、VTI相对变化率能够预测单肺通气患者的容量反应性。Objective To explore the value of hemodynamic changes induced by the tidal volume challenge(V_(T)C)in assessing the fluid responsiveness during one-lung ventilation(OLV).Methods Fifty-eight patients,25 males and 33 females,aged 18-64 years,BMI 18-25 kg/m^(2),ASA physical statusⅠ-Ⅲ,were selected for thoracoscopic OLV surgery under general anesthesia.HR and MAP were recorded at OLV 15 minutes(before V_(T)C),2 minutes after performing V_(T)C(after V_(T)C),2 minutes after adjusting V_(T) back to 5 ml/kg[before volume-load test(VLT)]and after VLT.Transesophageal echocardiography(TEE)was used to measure and record the patient s left ventricular outflow tract(LVOT)diameter in mid-esophageal view,aortic valve velocity time integral(VTI)in long-axis view of the fundus and stroke volume(SV)at the above four time points.The relative change in SV before and after V_(T)C(ΔSV-V_(T)C),relative change in VTI before and after V_(T)C(ΔVTI-V_(T)C),relative change in MAP before and after V_(T)C(ΔMAP-V_(T)C),and relative change in SV before and after volume loading test(ΔSV-VLT)were calculated.Patients were divided into two groups according toΔSV-VLT:responders(group R,ΔSV-VLT≥10%)and non-responders(group NR,ΔSV-VLT<10%).Receiver operating characteristic(ROC)curves for each indicator were generated,and the area under the curve(AUC)were calculated to evaluate the ability to discriminate the fluid responders from the nonresponders.Results There were 32 responders(55%).AUC forΔSV-V_(T)C to discriminate responders from nonresponders were 0.81(95%CI 0.68-0.90).The best threshold forΔSV-V_(T)C was-16.1%,with a sensitivity of 78.1%and a specificity of 84.6%.AUC forΔVTI-V_(T)C to discriminate the responders from the nonresponders were 0.79(95%CI 0.66-0.89).The best threshold forΔVTI-V_(T)C was-14.5%,with a sensitivity of 78.1%and a specificity of 80.8%.AUC forΔMAP-V_(T)C to discriminate responders from nonresponders were 0.56(95%CI 0.42-0.69).The best threshold forΔMAP-V_(T)C was-5.1%,with a sensitivity of 53.1%and a speci

关 键 词：潮气量负荷试验 单肺通气 容量反应性 每搏量 

分 类 号：R614[医药卫生—麻醉学]