肺复张诱导主动脉瓣速度时间积分变化评估肺保护性通气患者容量反应性的临床研究  

Clinical research of the changes in aortic valve velocity time integral induced by lung recruitment maneuver to evaluate fluid responsiveness in patients with lung‑protective ventilation

作　　者：李勇 高巨 罗超 葛亚丽 陈勇 Li Yong;Gao Ju;Luo Chao;Ge Yali;Chen Yong(Department of Anesthesiology,Clinical Medical School of Yangzhou University,Northern Jiangsu People's Hospital,Yangzhou 225001,China;Department of Cardiac Function Examination,Clinical Medical School of Yangzhou University,Northern Jiangsu People's Hospi-tal,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,扬州225001 [2]扬州大学临床医学院,江苏省苏北人民医院心功能检查科,扬州225001

出　　处：《国际麻醉学与复苏杂志》2023年第6期605-609,共5页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(81601679)。

摘　　要：目的评价肺复张诱导主动脉瓣速度时间积分(velocity time integral,VTI)变化评估肺保护性通气患者容量反应性的准确性。方法择期全麻下行胃肠手术的患者45例,年龄50~70岁,ASA分级Ⅰ、Ⅱ级,左室射血分数(left ventricular ejection fractions,LVEF)>55%。所有患者全麻诱导气管插管后行肺保护性通气[潮气量7 ml/kg,呼气末正压(positive end expiratory pressure,PEEP)5 cmH_(2)O(1 cmH_(2)O=0.098 kPa)通气,FIO_(2)60%],待血流动力学平稳后,给予一次肺复张(lung recruitment maneuver,RM)。于心尖五腔心切面,将脉冲多普勒取样点置于距主动脉瓣1 cm之内,描记VTI。记录RM前后VTI、MAP和心率,并计算速度时间积分变异度(velocity time integral variation,△VTI)、平均动脉压变异度(mean arterial pressure variation,△MAP)和心率变异度(heart rate variation,△HR)。暂将潮气量改为9 ml/kg并连接Vigileo系统后行容量负荷试验(volume expansion,VE),记录容量负荷试验前后每搏量(stroke volume,SV),并计算每搏量变异率(stroke volume variation,△SV)。依据△SV将患者分为两组:有反应组(R组,△SV≥15%,26例)和无反应组(N组,△SV<15%,19例)。采用受试者工作特征(receiver operating characteristic,ROC)曲线对△VTI、△MAP和△HR进行分析,并计算最佳Youden指数时各指标值,评价RM诱导△VTI评估肺保护性通气患者容量反应性的准确性。结果与RM前比较,两组患者RM后MAP、VTI均明显下降(P<0.05);两组患者RM前后心率差异无统计学意义(P>0.05)。与N组比较,R组△HR升高(P<0.05),△MAP和△VTI降低(P<0.05)。ROC曲线分析结果示:△VTI预测肺保护性通气患者容量反应性阳性的诊断阈值为18.065%,灵敏度为92.3%,特异度为73.7%,曲线下面积(area under curve,AUC)为0.893(95%CI 0.800~0.986,P<0.05);△MAP预测肺保护性通气患者容量反应性阳性的诊断阈值为11.120%,灵敏度为73.1%,特异度为84.2%,AUC为0.864(95%CI 0.762~0.967,P<0.05);△HR预测肺保护�Objective To evaluate the accuracy of changes in aortic valve velocity time integral(VTI)induced by lung recruitment maneuver for evaluating fluid responsiveness in patients with lung-protective ventilation.Methods A total of 45 patients,aged 50 to 70 years,American Society of Anesthesiologists(ASA)classⅠorⅡ,with>55%left ventricular ejection fractions(LVEF),who underwent elective gastrointestinal surgery under general anesthesia were enrolled.After tracheal intubation under general anes⁃thesia,all the patients underwent lung-protective ventilation[tidal volume 7 ml/kg,positive end expiratory pressure(PEEP)5 cmH_(2)O (1 cmH_(2)O=0.098 kPa), and FiO_(2) 60%]. When hemodynamics became stable, single lung recruitment maneuver (RM) was performed. In the apical five chamber view, the pulse Doppler sampling point was placed within 1 cm of the aortic valve to record the aortic valve VTI. Furthermore, VTI, MAP and heart rate were recorded before and after lung recruitment maneuver, and velocity time integral varia⁃tion (△VTI), mean arterial pressure variation (△MAP), and heart rate variation (△HR) were calculated. Then, the tidal volume was changed to 9 ml/kg and the Vigileo system was collected to perform the volume expansion (VE) test. The stroke volume (SV) was record⁃ed before and after the VE test and stroke volume variation (△SV) was calculated. According to △SV, the patients were divided into two groups: a response group (group R, △SV≥15%, n=26) and a non-response group (group N, △SV<15%, n=19). A receiver operat⁃ing characteristic curve was plotted to analyze the △VTI, △MAP and △HR, and each indicator was calculated at the optimal Youden index. The accuracy of RM in evaluating fluid responsiveness in patients with lung-protective ventilation was evaluated. ResultsCompared with those before RM, both groups showed significant decreases in MAP and VTI after RM (P<0.05), and there were no sta⁃tistical differences in heart rate before and after RM in the two groups (P>0.05). Compared

关 键 词：肺复张 速度时间积分 肺保护性通气 容量反应性 

分 类 号：R614[医药卫生—麻醉学]