每搏量变异度对侧卧折刀位机器人辅助腔镜手术患者容量反应性的预测价值  

Predictive value of stroke volume variation on volume responsiveness of patients undergoing robot-assisted endoscopic surgery with lateral jackknife position

作　　者：冉景航 林显健 曾榆芙 孙怡[2] RAN Jinghang;LIN Xianjian;ZENG Yufu;SUN Yi(Guangdong Provincial Cardiovascular Diseases Institute,Guangzhou,Guangdong 510080,China;Department of Anesthesiology,Guangdong Provincial People’s Hospital/Guangdong Provincial Academy of Medical Sciences,Guangzhou,Guangdong 510080,China)

机构地区：[1]广东省心血管病研究所,广州510080 [2]广东省人民医院/广东省医学科学院麻醉科,广州510080

出　　处：《重庆医学》2023年第21期3246-3252,共7页Chongqing medicine

摘　　要：目的探讨每搏量变异度(SVV)对侧卧折刀位机器人辅助腔镜手术患者容量反应性的预测价值。方法选取2021年10月至2022年5月在广东省人民医院接受侧卧折刀位下机器人辅助腔镜手术治疗的33例患者为研究对象。按照补液试验后每搏输出量(SV)升高是否≥10%将所有患者分为容量反应阳性(Rs)组与容量反应阴性(NRs)组。在麻醉诱导后气腹建立完成时行补液试验,分别记录两组补液试验前后心率(HR)、平均动脉压(MAP)、SV、心输出量(CO)、心指数(CI)、中心静脉压(CVP)和SVV。采用Pearson相关性分析,曲线下面积(AUC)评估各指标对患者容量反应性的预测能力。结果33例患者中Rs组16例,NRs组17例,两组一般资料和术中情况比较差异无统计学意义(P>0.05)。SV变化值与SVV相关(r=0.348,P=0.047),与MAP、CO、CVP不相关(r=-0.303、-0.160、0.068,P>0.05)。SVV的AUC为0.858,明显大于MAP、HR、CVP等血流动力学指标,SVV的诊断阈值为14%,灵敏度为81.25%,特异度为23.53%。结论在侧卧折刀位下行机器人辅助腔镜手术时SVV可较好地预测患者的容量反应性。Objective To explore the predictive value of stroke volume variation(SVV)for the volume responsiveness of the patients undergoing robot-assisted laparoscopic surgery with lateral jackknife position.Methods A total of 33 patients receiving robot-assisted urological surgery with lateral jackknife position in Guangdong Provincial People’s Hospital from October 2021 to May 2022 were selected as the research subjects and divided into the volume response positive(Rs)group and the volume response negative(NRs)group according to whether the stroke volume(SV)increase≥10%after rehydration test.After completing the pneumoperitoneum establishment after anesthesia induction,the fluid infusion test was conducted,and the heart rate(HR),mean arterial pressure(MAP),SV,cardiac output(CO),cardiac index(CI),central venous pressure(CVP)and SVV were recorded before and after the fluid infusion test.The Pearson correlation analysis and area under curve(AUC)were used to evaluate the predictive ability of each index on the patients’volume responsiveness.Results Among all 33 patients,16 cases were enrolled in the Rs group and 17 cases were enrolled in the NRs group,respectively.There was no statistically significant difference in the general data and intraoperative conditions between the two groups(P>0.05).The change value of SV was correlated to SVV(r=0.348,P=0.047),but had no correlated to MAP,CO and CVP(r=-0.303,-0.160,0.068,P>0.05).AUC of SVV was 0.858,which was significantly higher than the hemodynamic indexes such as MAP,HR and CVP.The diagnostic threshold value of SVV was 14%,the sensitivity was 81.25%and the specificity was 23.53%.Conclusion SVV could well predict the volume responsiveness of the patients during robot-assisted endoscopic surgery in the lateral jackknife position.

关 键 词：每搏量变异度 侧卧折刀位 机器人辅助腔镜手术 容量反应性 动态血流动力学指标 

分 类 号：R614.1[医药卫生—麻醉学]