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| 颈动脉峰值流速变异率评估腹腔镜手术患者容量反应性的价值 |
| Vadilidation of respirophasic variation in carotid artery blood flow peak velocity as predictors of fluid responsiveness in patients undergoing laparoscopic surgery |
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| DOI：10.12089/jca.2018.02.001 |
| 中文关键词: 容量 腹腔镜 颈动脉峰值流速变异率 气腹压 心脏指数 |
| 英文关键词: Volume Laparoscopic Respirophasic variation in carotid artery blood flow peak velocity Intra-abdominal pressure Cardiac index |
| 基金项目:江苏省青年医学重点人才项目(QNRC2016338) |
| 作者 | 单位 | E-mail | | 王骁颖 | 225001,扬州市,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | | | 张扬 | 225001,扬州市,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | | | 高巨 | 225001,扬州市,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | doctor2227@163.com | | 彭艺 | 225001,扬州市,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | | | 黄天丰 | 225001,扬州市,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | | | 王存金 | 225001,扬州市,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | |
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| 中文摘要: |
| 目的 探讨颈动脉峰值流速变异率(respirophasic variation in carotid artery blood flow peak velocity,ΔVpeak-CA)评估腹腔镜手术患者容量反应性的准确性和可行性。方法 选择择期行腹腔镜下手术患者55例,男29例，女26例,年龄45～75岁, BMI 20～24 kg/m2, ASA Ⅰ～Ⅲ级。在气腹压稳定于13～15 mm Hg后, 20 min内快速静脉输注羟乙基淀粉130/0.4氯化钠注射液7 ml/kg。以心脏指数(cardiac index,CI)的增长量(ΔCI)≥15%作为液体反应阳性的判定标准, 分为有反应组(R组，n=32)和无反应组(NR组，n=23),并绘制ΔVpeak-CA判断容量变化的受试者工作特性曲线（receiver operating characteristic curve, ROC）, 计算诊断阈值、曲线下面积（area under curve, AUC）和95%可信区间(CI)。记录麻醉诱导后5 min(气腹前,T1)、气腹压上调稳定于13～15 mm Hg 5 min后(T2)、补液后5 min(T3)的每博变异率(SVV)、ΔVpeak-CA和CI。结果 气腹下补液前ΔVpeak-CA与CI呈高度负相关(r=-0.843, P＜0.001)。ΔVpeak-CA评估容量反应性的ROC曲线的AUC为0.884 (95%CI 0.793～0.975), 诊断阈值为17.85%, 判断液体反应性的灵敏度为81.3%, 特异度为91.3%。结论 ΔVpeak-CA可作为腹腔镜手术患者评估容量反应性的可靠指标。 |
| 英文摘要: |
| Objective To assess the accuracy and feasibility of respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak-CA) as predictors of fluid responsiveness in laparoscopic surgery. Methods Fifty-five patients undergoing laparoscopic surgeries, 29 males and 26 females, aged 45-75 years, ASA physical status Ⅰ-Ⅲ, with body mass index 20-24 kg/m2, were enrolled. When intra-abdominal pressure was steady at the level of 13-15 mm Hg, 6% hydroxyethylstarch (HES 130/0.4) 500 ml was infused at the speed of 7 ml/kg within 20 minutes. After volume expansion, subjects were classified as responders (group R, n=32) if cardiac index increased (ΔCI) was≥15% and no responders (group NR, n=23) as ΔCI<15%. The receiver operating characteristic curve (ROC) curve for ΔVpeak-CA in determining the volume expansion responsiveness was plotted, and the diagnostic threshold was determined. The area under curve (AUC) and 95% confidence interval (CI) was calculated. Cardiac index (CI), ΔVpeak-CA and stroke volume variation (SVV) were independently recorded at 5 minutes after induction (T1), 5 minutes after intra-abdominal pressure were stable at the level of 13-15 mm Hg (T2) and 5 minutes after volume expansion (T3). Results ΔVpeak-CA is highly negatively correlated with CI (r=-0.843, P＜0.001). The results of ROC curve analysis showed, ΔVpeak-CA threshold discriminated between responders and non-responders with a sensitivity of 81.3% and a specificity of 91.3%, and the AUC was 0.884 (95% CI 0.793-0.975). Conclusion ΔVpeak-CA seems to be a highly feasible and reliable predictor for fluid responsiveness in laparoscopic surgery patients. |
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