|
| 下腔静脉呼吸变异度预测下肢驱血带引起容量变化的研究 |
| Prediction of volume responsiveness during tourniquet usage by inferior vena cava respiratory variability |
| |
| DOI：10.12089/jca.2018.11.006 |
| 中文关键词: 下腔静脉呼吸变异度 容量反应性 驱血带 |
| 英文关键词: Inferior vena cava respiratory variability Volume responsiveness Tourniquet |
| 基金项目:上海卫生计生委科研课题(201540316) |
|
| 摘要点击次数: 3237 |
| 全文下载次数: 2073 |
| 中文摘要: |
目的 在全麻机械通气条件下运用下腔静脉呼吸变异度(VIVC)评估下肢骨科手术中上驱血带引起的容量变化。
方法 选取2017年3月至2017年10月拟在全麻联合神经阻滞下行单下肢lisfranc损伤手术患者37例, 男19例, 女18例, 年龄25～50岁, BMI 20～30 kg/m2, ASA Ⅰ或 Ⅱ级。所有患者在全身麻醉联合神经阻滞下记录上驱血带前即刻和上驱血带后即刻HR、平均动脉压(MAP)、每搏量(SV)和上驱血带前即刻下腔静脉呼吸变异率(VIVC)。根据上驱血带前即刻和上驱血带后即刻SV增加百分比(ΔSV)是否≥13%将患者分为有反应组(ΔSV≥13%, R组)和无反应组(ΔSV<13%, NR组), R组18例, NR组19例。分析VIVC与ΔSV的相关性, 绘制VIVC的受试者工作特征曲线(ROC曲线), 评估VIVC评测使用上驱血带造成的容量变化的临床价值。
结果 R组上驱血带前即刻SV明显低于上驱血带后即刻(P<0.05)。上驱血带前即刻R组VIVC明显高于NR组(P<0.05)。VIVC与ΔSV呈线性正相关关系（r=0.627, P<0.001）。将诊断金标准定为ΔSV≥13%, 进行VIVC的ROC曲线绘制, 计算得出曲线下面积(AUC)是0.886(95%CI 0.734～1.000, P<0.01)。VIVC判断容量变化的阈值是15.97%, 灵敏度88.9%, 特异度为93.3%。
结论 在下肢骨科手术中, 上驱血带前VIVC与上驱血带引起的SV变化值呈线性正相关关系, 使用超声测量的VIVC能对驱血引起的容量变化进行预测, 当VIVC为15.97%时, 其预测灵敏度88.9%, 特异度为93.3%。 |
| 英文摘要: |
Objective To evaluate the ability of the inferior vena cava respiratory variability(VIVC) in predicting the patient′s volume responsiveness during the period of tourniquet usage in the lower limb orthopedics under the condition of general anesthesia.
Methods From March 2017 to October 2017, 37 patients with single lower extremity lisfranc injury under general anesthesia combined with nerve block were selected, including 19 males and 18 females, aged 25 - 50 years, with a BMI 20 - 30 kg/m2 and ASA physical status Ⅰ or Ⅱ. HR, MAP, SV before and after tourniquet usage under general anesthesia combined with nerve block were recorded. The inferior vena cava respiratory variability (VIVC) was recorded before tourniquet usage. Patients were divided into responding group (ΔSV ≥ 13%, group R) and non-responding group (ΔSV < 13%, group NR) according to whether the percentage of SV increase (ΔSV) before and after tourniquet usage was ≥ 13%, of which group R 18 cases, 19 cases in group NR. The correlation between VIVC and ΔSV was analyzed, and the receiver operating characteristic curve (ROC curve) of VIVC was drawn to evaluate the clinical value of the change in volume caused by tourniquet usage before VIVC.
Results SV of patients in group R was significantly higher than that before the tourniquet usage (P < 0.05). The VIVC in group R before the tourniquet usage was significantly higher than that in group NR (P < 0.05). There was a linear positive correlation between VIVC and ΔSV, r = 0.627, P<0.001. When the diagnostic gold standard was set as ΔSV ≥ 13%, the AUC was calculated to be 0.886 (95% CI 0.734 - 1.000, P<0.01). The threshold for VIVC to judge the change in capacity was 15.97%, the sensitivity was 88.9%, and the specificity was 93.3%.
Conclusion In the lower extremity orthopedic surgery, VIVC was linearly positively correlated with ΔSV before and after tourniquet usage. VIVC with ultrasound measurement can predict the volume change caused tourniquet usage. When VIVC is 15.97%, its prediction sensitivity is 88.9%. The specificity is 93.3%. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
