国际麻醉学与复苏杂志   2020, Issue (11): 0-0
    
胸科手术中影响每搏变异度反应容量准确性的因素
薛梅, 罗婷, 吴安石1()
1.北京朝阳医院
Influencing factors of predictive accuracy of stroke volume variation during thoracic surgery
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摘要:

每搏变异度(stroke volume variation, SVV)是动态监测循环容量和预测前负荷反应性的重要血流动力学指标,具有敏感、准确、安全等特点。SVV由心肺的相互作用产生,可通过动脉压力波形分析技术进行连续监测,其与容量变化的相关性优于静态血流动力学指标,但SVV是否适用于胸科手术一直存在争论。文章综述了SVV监测胸科手术单肺通气(one‑lung ventilation, OLV)时不同穿刺部位、体位变化、心血管功能和肺通气中不同通气模式、潮气量与呼吸频率、呼气末正压以及手术中OLV、开放胸腔、肺复张不同时段等多种影响血容量变化准确性的因素及其研究进展,从而帮助临床上更加安全、有效地进行患者围手术期的容量管理。

关键词: 每搏变异度; 血流动力学; 液体管理; 单肺通气
Abstract:

Stroke volume variation (SVV) is an important hemodynamic index for dynamically monitoring circulatory volume and predicting preload responsiveness, which is sensitive, accurate, and safe. SVV is produced by the interaction between heart and lung, and can be continuously monitored by arterial pressure waveform analysis technology. The correlation between SVV and volume change is better than that of static hemodynamic index. However, whether SVV is suitable for thoracic surgery has always been controversial. This paper reviews the monitoring of one‑lung ventilation (OLV) in thoracic surgery by SVV, including different puncture sites, body position changes, cardiovascular function and different ventilation modes in lung ventilation, tidal volume and respiratory rate, positive end expiratory pressure, as well as OLV during operation, open chest, lung recruitment and other factors that affect the accuracy of blood volume change and its research progress, so as to help the clinical perioperative volume management of patients more safely and effectively

Key words: Stroke volume variation; Hemodynamic; Fluid management; One‑lung ventilation