个体化微量液体冲击试验判断俯卧位手术患者容量反应性的有效性  

Efficacy of individualized mini-fluid challenge test in determining fluid responsiveness in patients undergoing surgery in prone position

作　　者：杨雪梅 刘敏于 范晓君 徐世元[2] 张鸿飞[2] Yang Xuemei;Liu Minyu;Fan Xiaojun;Xu Shiyuan;Zhang Hongfei(Department of Anesthesiology,Chongqing University Cancer Hospital,Chongqing 400030,China;Department of Anesthesiology,Zhujiang Hospital of Southern Medical University,Guangzhou 510282,China)

机构地区：[1]重庆大学附属肿瘤医院麻醉科,重庆400030 [2]南方医科大学珠江医院麻醉科,广州510282

出　　处：《中华麻醉学杂志》2023年第8期972-976,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价个体化微量液体冲击试验判断俯卧位手术患者容量反应性的有效性。方法选择择期行俯卧位下脊柱手术患者47例,性别不限,年龄>18岁,BMI 18~30 kg/m^(2),ASA分级Ⅰ或Ⅱ级。采用容量控制模式机械通气,设置潮气量8 ml/kg。采用FloTrac/Vigileo系统监测血流动力学参数。气管插管后5 min(T_(1))时改为俯卧位,俯卧位5 min(T_(2))时静脉输注羟乙基淀粉130/0.4氯化钠注射液2 ml/kg。输注完2 ml/kg液体后1 min(T_(3))时再输注3 ml/kg液体,输注速率均为0.5 ml·kg^(-1)·min^(-1)。T_(2)至T_(3)为微量液体冲击试验;T_(2)至输注完3 ml/kg液体后1 min(T_(4))时为标准容量治疗(共输注5 ml/kg液体)。计算T_(3)时点相对于T_(2)时点每搏量(SV)的变化率(ΔSVT_(3))和T_(4)时点相对于T_(2)时点SV的变化率(ΔSVT_(4)),以ΔSVT_(4)≥10%为容量反应性试验阳性,将患者分为有容量反应组(Rs组)和无容量反应组(NRs组)。选择ΔSVT_(3)、ΔSVT_(4)、T_(3)和T_(4)时点每搏量变异度(SVV)和脉压变异度(PPV),绘制判断容量反应性的受试者工作特征曲线(ROC),并计算曲线下面积(AUC)。结果最终纳入41例患者,Rs组18例,NRs组23例。ΔSVT_(3)判断患者容量反应性的AUC为0.976,灵敏度为0.944,特异度为0.957;ΔSVT_(4)判断患者容量反应性的AUC为0.971,灵敏度为0.889,特异度为0.957。T_(3)和T_(4)时点SVV判断患者容量反应性的AUC分别为0.632、0.609;T_(3)和T_(4)时点PPV判断患者容量反应性的AUC分别为0.470、0.380。结论个体化微量液体冲击试验(2 mg/kg胶体液)可准确判断俯卧位手术患者的容量反应性。Objective To evaluate the efficacy of individualized mini-fluid challenge test in determining the fluid responsiveness in the patients undergoing surgery in prone position.Methods A total of 47 patients of either sex,aged>18 yr,with boy mass index of 18-30 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,undergoing elective spinal surgery in prone position,were included.The volume-controlled mode was used for mechanical ventilation,and the tidal volume was set at 8 ml/kg.The hemodynamic parameters were monitored by FloTrac/Vigileo system.The patient was changed to prone position at 5 min after endotracheal intubation(T_(1)),hydroxyethyl starch 130/0.4 sodium chloride injection 2 ml/kg was intravenously given at 5 min of prone position(T_(2)),and fluid 3 ml/kg was continuously infused at 1 min after 2 ml/kg fluid infusion(T_(3)),and both infusion rates were 0.5 ml·kg^(-1)·min^(-1).A mini-fluid challenge test was performed during T_(2)-T_(3) period,the standard volume therapy(total infusion of liquid 5 ml/kg)was carried out from T_(2) to 1 min after infusion of liquid 3 ml/kg(T_(4)).The rate of change in SV at T_(3) time point(ΔSVT_(3))was calculated relative to T_(2) time point,and the rate of change in SV at T_(4) time point(ΔSVT_(4))was calculated relative to T_(2) time point.Positive fluid responsiveness test was defined as an increase inΔSVT_(4)≥10%,and patients were divided into volume response group(Rs group)and non-volume response group(NRs group).ΔSVT_(3),ΔSVT_(4) and stroke volume variation and pulse pressure variation at T_(3) and T_(4) time points were selected,the receiver operating characteristic curve predicting fluid responsiveness was generated,and the area under the receiver operating characteristic curve(AUC)was calculated.Results Forty-one patients were finally enrolled,including 18 cases in Rs group and 23 cases in NRs group.The AUC ofΔSVT_(3) determining fluid responsiveness was 0.976,with the sensitivity 0.944 and specificity 0.957.The AUC of�

关 键 词：补液疗法 俯卧位 血管容量 

分 类 号：R687.3[医药卫生—骨科学]