|
摘要：
目的 探讨呼气末阻断（end expiratory obstruction, EEO）期间肱动脉峰流速变异度（brachial artery peak velocity variation, ΔVp）对老年患者术中容量反应性的预测作用。 方法 选择拟在全身麻醉下行择期胃肠手术的老年患者，ASA分级Ⅰ、Ⅱ级，心功能Ⅰ、Ⅱ级，麻醉诱导后所有患者先后进行EEO试验和容量负荷（volume expansion, VE）试验，记录EEO前、EEO期间、VE前、VE后的MAP、心率、CVP等血流动力学指标，计算各指标实验前后差值（Δ），记录EEO开始前每搏量变异度（stroke volume variation, SVV）。在EEO开始时、扩容前超声测量肱动脉峰流速并计算ΔVp。将扩容后每搏量增加值（increment rate of stroke volume, ΔSV）≥15%的患者纳入有反应组，<15%的患者纳入无反应组；共纳入84例患者，有反应组43例，无反应组41例。采用受试者工作特征（receiver operating characteristic curve, ROC）曲线评价各指标对容量反应性的预测作用。 结果 EEO试验前后和VE试验前后有反应组ΔMAP、ΔSV高于无反应组（P<0.05），心率差值（ΔHR）、ΔCVP两组差异无统计学意义（P>0.05），EEO试验前有反应组SVV高于无反应组（P<0.05）。有反应组EEO期间ΔVp和VE前ΔVp高于无反应组（P<0.05）。EEO试验前后ΔMAP、ΔHR、ΔCVP，EEO试验期间ΔVp及EEO前SVV预测容量反应性的曲线下面积（area under the curve, AUC）分别为0.862、0.615、0.514、0.524、0.797；VE试验前后ΔMAP、ΔHR、ΔCVP及VE前ΔVp预测容量反应性的AUC分别为0.667、0.521、0.542、0.779。EEO期间ΔVp≥30.2%为截断值，敏感度91.1%，特异性81.8%，EEO前SVV≥8.7%为截断值，敏感度84.5%，特异性73.4%，VE前ΔVp≥27.6%为截断值，敏感度81.5%，特异性72.8%。 结论 本研究中，EEO期间ΔVp≥30.2%可对老年患者术中患者容量反应性进行有效预测。
|
|
Abstract: Objective To explore the predictive effect of brachial artery peak velocity variation (ΔVp) during end expiratory occlusion (EEO) on volume response in elderly patients. Methods Elderly patients planning to undergo elective gastrointestinal surgery under general anesthesia, American Society of Anesthesiologists (ASA) ⅠorⅡ, cardiac function ⅠorⅡ, after anesthesia induction, EEO and volume expansion (VE) tests were successively performed in all patients. The hemodynamic indexes such as mean arterial pressure (MAP), heart rate (HR) and central venous pressure (CVP) were recorded before EEO, during EEO, before VE, after VE. Meanwhile, stroke volume variation (SVV) before EEO, the difference (Δ) before and after the experiment was recorded and calculated. At the timepoints before EEO and before VE, the peak velocity of brachial artery was measured by ultrasound while the variation peak velocity of brachial artery (ΔVp) was calculated. Patients with increment rate of stroke volume (ΔSV)≥15% were included in the responders group and ΔSV<15% in the non‑responders group. A total of 84 patients were included, 43 patients in the responders group while 41 patients in the non‑responders group. The receiver operating characteristic curve (ROC) curve was used to evaluate the predictive effect of each index on volume responsiveness. Results Before and after EEO and VE, ΔMAP and ΔSV in the responders group were significantly higher than those values in the non‑responders group (P<0.05). there was no significant difference of ΔHR and ΔCVP between the two groups (P>0.05). During EEO and before VE, ΔVp in the responders group were significantly higher than those values in the non‑responders group (P<0.05). The SVV in the responders group before EEO is significantly higher than that value in the non‑responders group (P<0.05). Area under the curve (AUC) of ΔVp, ΔMAP, ΔHR, ΔCVP in the EEO experiment and SVV before EEO by predicted fluid responsiveness were 0.862, 0.615, 0.514, 0.524, 0.797, respectively. The AUC of ΔMAP, ΔHR, ΔCVP in VE experiment and ΔVp before VE by predicted fluid responsiveness were 0.667, 0.521, 0.542, 0.779, respectively. During EEO, ΔVp≥30.2% is the cut off value;the sensitivity is 91.1%, the specificity is 81.8%. SVV≥8.7% before EEO is the cut off value. The sensitivity is 84.5% while the specificity is 73.4%. ΔVp≥27.6% before VE is the cut off value; the sensitivity is 81.5% while the specificity is 72.8%. Conclusions During EEO, ΔVp≥30.2% could effectively predict fluid responsiveness of elderly patients during operation.
|
