左室流出道ΔVpeak和ΔVTI对胃肠肿瘤术后急性循环衰竭老年患者容量反应性的预测效果  

Accuracy of ΔVpeak and ΔVTI of left ventricular outflow tract in predicting fluid responsiveness in elderly patients with acute circulatory failure after surgery for gastrointestinal neoplasms

作　　者：万静洁 徐丽[1] 解进[1] Wan Jingjie;Xu Li;Xie Jin(Department of Anesthesiology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院麻醉手术科,苏州215000

出　　处：《中华麻醉学杂志》2024年第4期457-460,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价左室流出道峰值速度呼吸变异度(ΔVpeak)和速度时间积分呼吸变异度(ΔVTI)对胃肠肿瘤术后急性循环衰竭老年患者容量反应性的预测效果。方法选择于2022年6月至2023年7月在本院择期行胃肠肿瘤手术后转入ICU且存在急性循环衰竭的老年患者76例,性别不限,年龄65~90岁。被动抬腿(PLR)试验前测定脉压变异度(PPV)。采用经胸超声心动图测量并计算ΔVpeak、ΔVTI和每搏量(SV)。PLR试验后SV增加(ΔSV)大于10%为患者存在容量反应性,并将患者分为2组:有反应组和无反应组。PPV、ΔVpeak、ΔVTI与ΔSV相关性采用Pearson相关分析。绘制受试者工作特征曲线,并计算曲线下面积(AUC),评估PPV、ΔVpeak和ΔVTI预测容量反应性的准确性。结果有反应组36例,无反应组40例。与无反应组相比,有反应组PPV、ΔVpeak和ΔVTI升高(P<0.05)。PPV、ΔVpeak、ΔVTI与ΔSV呈正相关(rPPV=0.485,95%CI 0.291~0.640;rΔVpeak=0.734,95%CI 0.610~0.823;rΔVTI=0.754,95%CI 0.636~0.837;P<0.001)。PPV预测容量反应性的AUC为0.686,截断值为8%,灵敏度为80.6%,特异度为47.5%;ΔVpeak预测容量反应性的AUC为0.868,截断值为12.2%,灵敏度为69.4%,特异度为90.0%;ΔVTI预测容量反应性的AUC为0.885,截断值为12.7%,灵敏度为77.8%,特异度为87.5%。结论左室流出道ΔVpeak和ΔVTI可准确预测胃肠肿瘤术后急性循环衰竭老年患者的容量反应性。Objective To evaluate the accuracy of the respiratory variability of peak velocity(ΔVpeak)and velocity-time integral(ΔVTI)of left ventricular outflow tract in predicting fluid responsiveness in elderly patients with acute circulatory failure after surgery for gastrointestinal neoplasms.Methods Seventy-six elderly patients of either gender,aged 65-90 yr,with acute circulatory failure admitted to the intensive care unit after elective surgery for gastrointestinal neoplasms in our hospital from June 2022 to July 2023,were selected.Pulse pressure variation(PPV)was measured before passive leg raising test.TheΔVpeak,ΔVTI and stroke volume(SV)were measured by echocardiography.The fluid responsiveness was defined as an increase in SV(ΔSV)>10%after passive leg raising test,and the patients were divided into 2 groups:responsiveness group and non-responsiveness group.The correlations between PPV,ΔVpeak,ΔVTI andΔSV were evaluated by Pearson′s correlation.The receiver operating characteristic curve was plotted,and the area under the receiver operating characteristic curve(AUC)was calculated,and the accuracy of PPV,ΔVpeak andΔVTI in predicting fluid responsiveness was assessed.Results There were 36 cases in responsiveness group and 40 cases in non-responsiveness group.The PPV,ΔVpeak,andΔVTI were significantly higher in responsiveness group than in non-responsiveness group(P<0.05).PPV,ΔVpeak andΔVTI were positively correlated withΔSV(rPPV=0.485,95%confidence interval[CI]0.291-0.640;rΔVpeak=0.734,95%CI 0.610-0.823;rΔVTI=0.754,95%CI 0.636-0.837;P<0.001).The AUC of PPV in predicting fluid responsiveness was 0.686,the cut-off value was 8%,the sensitivity was 80.6%,and the specificity was 47.5%.The AUC ofΔVpeak in predicting fluid responsiveness was 0.868,the cut-off value was 12.2%,the sensitivity was 69.4%,and the specificity was 90.0%.The AUC ofΔVTI in predicting fluid responsiveness was 0.885,the cut-off value was 12.7%,the sensitivity was 77.8%,and the specificity was 87.5%.Conclusions TheΔVpeak andΔVTI o

关 键 词：血管容量 超声心动描记术 多普勒 老年人 胃肠肿瘤 

分 类 号：R735[医药卫生—肿瘤] R614[医药卫生—临床医学]