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摘要：
目的 探究气腹合并头高脚低位15°~30°条件下每搏量变异度（stroke volume variation, SVV）预测老年患者液体反应性的准确性及诊断阈值。 方法 择期全身麻醉下行腹腔镜下胃癌根治术的老年患者80例。于气腹合并体位变动后5 min（T1），静脉输注6%羟乙基淀粉130/0.4氯化钠注射液7 ml/kg，输注时间15~20 min。于T1、容量负荷后5 min（T2）时记录MAP、心率、心排血量（cardiac output, CO）、心指数（cardiac index, CI）、每搏量（stroke volume, SV）、每搏量指数（stroke volume index, SVI）和SVV。容量负荷后，以每搏量指数变化率（△SVI）≥15%为容量负荷试验阳性的标准，△SVI≥15%定义为有反应组（Rs组），△SVI<15%定义为无反应组（NRs组）。绘制SVV判断容量变化的受试者工作特征（receiver operating characteristic curve, ROC）曲线，计算ROC曲线下面积及95%CI。 结果 与T1时点比较，T2时点两组患者CI和SVI升高，SVV降低，差异有统计学意义（P<0.05）；Rs组T2时点CO和SV升高，差异有统计学意义（P<0.05）。两组患者T1时点比较，Rs组SVV高于NRs组，CI、SV、SVI和CO低于NRs组，差异有统计学意义（P<0.05）。患者心率、MAP组间及组内比较，差异均无统计学意义（P>0.05）。ROC曲线分析结果示：SVV区分容量负荷有无反应的阈值为16.5%时，灵敏度为95.9%，特异性为77.8%，曲线下面积（95%CI）为0.912（0.838~0.987）。 结论 在本实验条件下，SVV仍保持判断容量治疗反应的准确性，但其诊断阈值升高。SVV的诊断阈值为16.5%。
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Abstract: Objective To explore the accuracy and diagnostic threshold of stroke volume variation (SVV) in elderly patients under pneumoperitoneum in the reverse Trendelenburg position (15°~30°) to predict fluid responsiveness. Methods Eighty elderly patients who were scheduled for laparoscopic‑assisted radical gastrectomy under general anesthesia were enrolled. Then, 5 min after pneumoperitoneum combined with placement in the reverse Trendelenburg position (T1), 6% hydroxyethyl starch (HES) 130/0.4 in sodium chloride injection was intravenously infused at 7 ml/kg over 15 to 20 min. The mean arterial pressure (MAP), heart rate, cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume index (SVI) and SVV were recorded at T1 and 5 min after volume expansion (T2). After volume expansion, an increase in SVI (ΔSVI)≥15% was defined as the criterion for effective volume expansion. Patients with ΔSVI≥15% was defined as a response group (Rs group), while those with ΔSVI<15% was defined as a non‑response group (NRs group). The area under a receiver operating characteristic (ROC) curve for SVV was plotted, while the area under the curve for SVV and 95% confidence interval were calculated. Results Compared with those at T1, patients in both groups presented with remarkable increases in CI and SVI as well as decreases in SVV at T2 (P<0.05), significantly increased CO and SV were found in group Rs at T2 (P<0.05). At T1, the Rs group presented with marked higher SVV but lower CI, SV, SVI, and CO than the NRs group (P<0.05). There were no significant difference in the heart rate and MAP between the two groups (P>0.05). According to ROC curve analysis, when the threshold of SVV to distinguish responders and non‑responders was set as 16.5%, the sensitivity was 95.9%, the specificity was 77.8%, and the area under the curve was 0.912 (95%CI 0.838‒0.987). Conclusions Under the current conditions, SVV is still an accurate predictor to determine fluid responsiveness, with a diagnostic threshold of 16.5%, which is relatively high.
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