目的 探讨每搏量变异度(stroke volume variation, SVV)、脉搏压变异度(pulse pressure variation, PPV)对机器人辅助肝脏手术预测液体的准确性及阈值变化的价值。方法 选择拟在全身麻醉下行机器人辅助肝脏手术患者26例, 全身麻醉后连续监测心率(HR)、平均动脉压(MAP)、每搏量(SV)、每搏量指数(SVI)、SVV、PPV等血流动力学指标, 在反Trendelenburg体位下建立人工气腹后进行容量负荷试验, 记录输液前后各血流动力学指标数值, 然后以输液前后每搏量变异指数的差(ΔSVI)将患者分为两组, 即有反应组(ΔSVI≥15％)和无反应组(ΔSVI<15％)组, 绘制SVV和PPV判断扩容效应的受试者工作特征性(ROC)曲线, 确定机器人辅助肝脏手术特殊的体位及气腹条件下SVV和PPV预测容量状况的准确性、诊断阈值及两者的相关性。结果 SVV和PPV判断扩容有效的ROC曲线下面积分别为0.830和0.875, SVV的诊断阈值为13.5%, PPV的诊断阈值为14.5%, 两者的相关性为r=0.772(P<0.01)。结论 SVV和PPV均能准确预测机器人辅助肝脏手术中全身麻醉机械通气患者的容量状况, 两者预测容量状况的准确性相似且呈正相关, 但两者的诊断阈值较标准值均有所降低。
Abstract
Objective To evaluate the abilities and thresholds of stroke volume variation (SVV) and pulse pressure variation (PPV) in predicting fluid responsiveness during robot-assisted hepatic surgery. Methods 26 patients, undergoing robot-assisted hepatic surgery were studied. All patients were also monitored with Vigileo/FloTrac system. Haemodynamic data such as MAP, HR, SVI, SVV, PPV were recorded before and after volume expansion(HES 6%, 7 ml/kg). Fluid responsiveness was defined as an increase in SVI≥15%(△SVI≥15%). Results The SVV threshold of 13.5% before volume expansion was able to discriminate the responders from the non-responders with a sensitivity of 66.7%, and a specificity of 85.7%. The threshold for PPV was 14.5%, the sensitivity of 75% and specificity of 100% were obtained. There was no significant difference between the area under the receiver operating characteristics (ROC) curves of SVV and PPV (0.839, 0.875), and there was a significant correlation between the baseline SVV and the baseline PPV (r=0.772 , P<0.01).Conclusions SVV and PPV can predict fluid responsiveness accuratly during robot-assisted hepatic surgery, the baseline SVV is correlated well with baseline PPV, and the ability of SVV and PPV in predicting fluid responsiveness is similiar.
关键词
每搏量变异度 /
脉搏压变异度 /
气腹 /
反Trendelenburg体位 /
机器人辅助肝脏手术
Key words
stroke volume variation /
pluse pressure variation /
increased intra-abdominal pressure /
re-Trendelenburg position /
robot-assisted hepatic surgery
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参考文献
[1] Pelletier J S, Gill R S, Shi X, et al. Robotic-assisted hepatic resection: a systematic review[J]. Int J Med Robot, 2013, 9(3):262-267.
[2] Cannesson M, Besnard C, Durand P G, et al. Relation between respiratory variations in pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure in ventilated patients[J].Crit Care, 2005, 9(5):562-568.
[3] Xiaomei Liu, Qiang Fu, Weidong Mi, et al. Pulse pressure variation and stroke volume variation predict fluid responsiveness in mechanically ventilated patients experiencing intra-abdominal hypertension[J].Bio Science Trends, 2013, 7(2):101-108.
[4] Kumar A, Anel R, Bunnell E, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects[J]. Crit Care Med , 2004, 32(3):691-699.
[5] Soonawlla Z F, Stratopoulos C, Stoneham M, et al. Role of the reverse-Trendel-enberg patient position in maintaining low-CVP anaesthesia during liver resections[J].Langenbecks Arch Surg, 2008, 393(2): 195-198.
[6] Michard F, Teboul J L. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence[J]. Chest, 2002, 121(6):2000-2008.
[7] Michael R P, Didier P. Functional Hemodynamic Monitoring[J]. Crit Care, 2005, 9(6): 566-572.
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