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摘要：
目的 探讨MostCare监测每搏量变异度（stroke volume variation, SVV）和脉压变异率（pulse pressure variation, PPV）预测头低截石位宫腹腔镜手术患者容量反应的准确性。 方法 选择30例择期行宫腹腔镜手术的全身麻醉患者，ASA分级Ⅰ、Ⅱ级，年龄40~60岁。采用MostCare监测患者MAP、心率、每搏量（stroke volume, SV）、每搏输出量指数（stroke volume index, SVI）、心排血量（cardiac output, CO）、心脏指数（cardiac index, CI）、SVV、PPV等血流动力学指标。手术开始建立人工气腹血流动力学平稳后，在头低截石位下10~15 min内输注6%羟乙基淀粉130/0.4电解质注射液7 ml/kg进行容量负荷试验。记录麻醉后平卧位气腹前（T1）、人工气腹后头高截石位容量负荷试验前（T2）、容量负荷试验结束后（T3）的上述血流动力学指标。以容量负荷试验前后SVI差值（△SVI）=15%为标准，分为有反应组（△SVI≥15%，16例）和无反应组（△SVI<15%，14例）。绘制SVV和PPV的受试者工作特征（receiver operating characteristics, ROC）曲线，预测容量反应的准确性和诊断阈值。 结果 与T1比较，T2时有反应组CO及T2、T3时两组SVV、PPV降低（P<0.05）；与T2比较，T3时两组SVV和PPV降低（P<0.05），有反应组SV、SVI、CO和CI升高（P<0.05）；T2时无反应组SVV和PPV值低于有反应组（P<0.05）。其余指标差异无统计学意义（P>0.05）。SVV和PPV预测容量反应有效的ROC曲线下面积（area under curve, AUC）分别为0.81和0.94，SVV和PPV的诊断阈值分别为8.0%和7.5%，敏感度分别为75.0%和87.5%，特异性分别为78.6%和92.9%。 结论 MostCare监测SVV和PPV均可预测头低截石位宫腹腔镜手术患者的容量变化，但两者诊断阈值较标准值均降低，且PPV的准确性高于SVV。
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Abstract: Objective To investigate the accuracy of stroke volume variation (SVV) and pulse pressure variation (PPV) by MostCare in predicting the fluid responsiveness of patients undergoing laparoscopic hysteroscopy in the head‑down lithotomy position. Methods A total of 30 patients, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ, aged 40 to 60, who were scheduled for laparoscopic hysteroscopy under general anesthesia were enrolled. Their hemodynamic data, including mean arterial pressure (MAP), heart rate, stroke volume (SV), stroke volume index (SVI), cardiac output (CO), cardiac index (CI), SVV and PPV were monitored by MostCare. After establishment of artificial pneumoperitoneum, the patients were injected with 6% hydroxyethyl starch (HES 130/0.4) at 7 ml/kg over 10‒15 min in the head‑down lithotomy position. The above hemodynamic data were recorded before establishment of artificial pneumoperitoneum (T1), after establishment of artificial pneumoperitoneum and before volume expansion in the head‑down lithotomy position (T2), and after volume expansion (T3). According to the difference in SVI (△SVI), the patients were divided into two groups: a response group (△SVI≥15%, n=16) and a non‑response group (△SVI<15%, n=14). The receiver operating characteristics (ROC) curve was plotted for SVV and PPV to predict the accuracy of volume expansion, and determine their diagnostic thresholds. Results Compared with those at T1, remarkable decreases were found in CO for the response group and in SVV and PPV for both groups at T2 and T3 (P<0.05). Compared with those at T2, both groups presented decreased SVV and PPV at T3 (P<0.05). At T3, SV, SVI, CO and CI in the response group were significantly higher than those at T2 (P<0.05). At T2, SVV and PPV in the non‑response group were significantly lower than those in the response group (P<0.05). No statistical difference was found in other indicators between the two groups (P>0.05). The area under curve (AUC) of ROC curve was 0.81 and 0.94, for SVV and PPV respectively. The diagnostic threshold of SVV and PPV were 8.0% and 7.5%, with a sensitivity of 75.0% and 87.5%, and a specificity of 78.6% and 92.9% respectively. Conclusions SVV and PPV can predict the fluid responsiveness of patients in the head‑down lithotomy position under laparoscopic hysteroscopy, but their diagnostic thresholds decreased, compared with the standard thresholds, and PPV was superior to SVV in accuracy.
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