肺部超声预测腹腔镜直肠癌根治术患者容量反应性的准确性  

The accuracy of pulmonary ultrasound in predicting volume responsiveness in patients undergoing laparoscopic radical resection of rectal cancer*

作　　者：齐丽君 彭艺 赵峰[1] 张同楠 QI Lijun;PENG Yi;ZHAO Feng;ZHANG Tongnan(Department of Anesthesiology,Heze Municipal Hospital,Shandong 274000)

机构地区：[1]菏泽市立医院麻醉科,山东274000

出　　处：《南通大学学报(医学版)》2025年第1期39-42,共4页Journal of Nantong University(Medical sciences)

基　　金：菏泽市立医院科技发展计划项目(2021YN43)。

摘　　要：目的:探讨肺部超声预测腹腔镜直肠癌根治术患者容量反应性的准确性。方法:选取60例年龄在40~65岁、性别不限、ASA分级Ⅰ或Ⅱ级的腹腔镜直肠癌根治术患者。分别在麻醉诱导后和气腹后测量每搏量变异度、每搏量指数(stroke volume index,SVI)、心排指数等参数,并用肺部超声扫描患者胸壁,进行肺部超声评分(lung ultrasound score,LUS)。然后将7 mL/kg的羟乙基淀粉氯化钠200/0.5按患者体质量静脉注射,于15 min完成输入,再记录各参数。将补液后SVI升高≥15%作为容量反应性阳性标准,对AUC及95%CI进行ROC曲线绘制。结果:容量反应阴性组和阳性组差异较大,以LUS评分=1.5分为截断值,评估容量反应性的灵敏度为0.765,特异度为0.808,AUC>0.700。结论:肺部超声预测腹腔镜直肠癌根治术患者容量反应性的准确性较高,且无创便捷,有利于临床推广。Objective:To explore the accuracy of pulmonary ultrasound in predicting volume responsiveness in patients undergoing laparoscopic radical resection of rectal cancer.Methods:Sixty patients who underwent laparoscopic radical resection for rectal cancer were selected,aged 40-65 years old,regardless of gender,with ASA gradeⅠorⅡ.Measure parameters such as stroke volume variability,stroke volume index(SVI),and cardiac output index after anesthesia induction and pneumoperitoneum,and use pulmonary ultrasound to scan the patient's chest wall and perform lung ultrasound score(LUS).Then,according to the patient's weight,intravenous infusion of hydroxyethyl starch 200/0.5 sodium chloride was administered at 7 mL/kg,and the infusion was completed within 15 minutes.After that,all parameters were recorded.After the surgery is completed and the pneumoperitoneum is withdrawn,the final lung ultrasound score is completed and all parameters are recorded.Using a volume reactivity positive standard of≥15%increase in SVI after fluid replacement,plot the ROC curve,calculate the AUC,and the 95%CI.Results:The difference between the negative and positive groups in volume response was significant.Using LUS score of 1.5 as the cut-off value,the sensitivity and specificity of evaluating volume responsiveness were 0.765 and 0.808,AUC>0.700,respectively.Conclusion:Pulmonary ultrasound has a high accuracy in predicting volume responsiveness in patients undergoing laparoscopic radical resection of rectal cancer.It is non-invasive and convenient,which is conducive to clinical promotion.

关 键 词：肺部超声 腹腔镜 直肠癌根治术 容量反应性 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.3[医药卫生—诊断学]