国际麻醉学与复苏杂志   2019, Issue (8): 0-0
    
心脏外科术后桡动脉脉压变化预测每搏量变化的临床研究
侯君谊, 郑吉利, 屠国伟, 马国光, 杨晓梅, 苏迎, 罗哲, 王浩1()
1.复旦大学附属中山医院
Clinical study on the changes in radial artery pulse pressure to predict the changes in stroke volume after cardiac surgery
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摘要:

目的 探讨心脏外科术后患者容量负荷试验中桡动脉脉压(radial artery pulse pressure, rPP)的变化能否准确预测每搏量(stroke volume, SV)的变化。 方法 前瞻性收集了75例心脏外科术后接受机械通气的低血压患者,入组患者均接受了容量负荷试验,根据容量负荷试验的结果将患者分为阳性组(扩容后SV较基线水平增加≥15%,45例)和阴性组(扩容后SV较基线水平增加<15%,30例)。分别在基线水平和容量负荷试验后监测患者的心率、血压、MAP、CVP、SV、每搏量变异度(stroke volume variation, SVV)等血流动力学指标的变化。计算容量负荷试验后rPP的变化率及其预测SV增加≥15%的受试者工作特征曲线下面积(area under the receiver operating characteristic curve, AUC)、敏感性和特异性。 结果 本研究中60%的患者容量反应性阳性。阳性组患者容量负荷试验后血压、MAP、CVP、SV显著增加(P<0.05),而心率、SVV趋于降低。容量负荷试验rPP增加≥13%预测患者SV增加≥15%的AUC为0.90(95%CI 0.81~0.96),敏感度为0.82,特异度为0.83。 结论 容量负荷试验导致的rPP变化可以预测心脏外科术后患者SV的变化。

关键词: 容量反应性; 桡动脉; 脉压; 每搏量; 容量负荷试验; 心脏手术
Abstract:

Objective To evaluate whether the changes in the radial artery pulse pressure (rPP) can predict the changes in stroke volume (SV) after fluid challenge in patients after cardiac surgery. Methods This prospective observational study included 75 mechanical ventilated patients with hypotension after cardiac surgery, where all the patients involved underwent rPP and SV measurement after fluid challenges. Accordingly, the patients were divided into a volume responder group (increases in SV≥15%, n=45) and a non-responder group (increases in SV<15%, n=30). Then, heart rate (HR), blood pressure(BP), mean arterial pressure (MAP), central venous pressure (CVP), SV and stroke volume variation (SVV) were collected at baseline level and after fluid challenges respectively. The ability of the indices to predict fluid responsiveness, the area under the receiver operating characteristic curve (AUC), sensitivity and specificity for predicting fluid responsiveness were calculated.  Results In the study, 60% of the patients were defined as fluid responders. BP, MAP, CVP, SV increased significantly in the volume responder group(P<0.05), while HR and SVV tended to decrease. Increases in rPP induced by fluid challenges (≥13%) indicated SV increases (≥15%) with a sensitivity of 0.82 and a specificity of 0.83. The AUC was 0.90 [95% confidence interval(CI) 0.81-0.96].  Conclusions The changes in rPP induced by fluid challenges can be used to predict the changes in SV in patients after cardiac surgery.

Key words: Fluid responsiveness; Radial artery; Pulse pressure; Stroke volume; Fluid challenge; Cardiac surgery