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| 上腔静脉塌陷指数预测机械通气患者容量反应的可行性 |
| Feasibility of superior vena cava collapsibility predicting fluid responsiveness in mechanically ventilated patients |
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| DOI：10.12089/jca.2021.07.010 |
| 中文关键词: 上腔静脉塌陷指数 经食管超声心动图 容量反应 每搏量变异度 |
| 英文关键词: Superior vena cava collapsibility index Transesophageal echocardiography Fluid responsiveness Stroke volume variation |
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| 中文摘要: |
目的 探索上腔静脉塌陷指数（SVC-CI）对机械通气患者容量反应的预测效果。
方法 选择择期气管插管全麻机械通气下行腹部手术患者36例，男20例，女16例，年龄18~64岁，ASA Ⅰ或Ⅱ级，NYHA Ⅰ或Ⅱ级。所有患者在全麻诱导后至手术开始前，快速输注复方乳酸钠10 ml/kg，输注时间10～15 min。记录补液前后MAP、HR、CVP、心脏指数（CI）、每搏量变异度（SVV），利用经食管超声心动图测量上腔静脉（SVC）内径，并计算补液前后CI的变化值（ΔCI）以及SVC-CI。根据ΔCI将患者分为容量反应组（R组，ΔCI≥15%）和非容量反应组（NR组，ΔCI＜15%）。采用受试者工作特征（ROC）曲线评估SVC-CI和SVV预测容量反应的效能。
结果 有20例（56%）患者出现容量反应。R组SVC-CI明显高于NR组（P＜0.05）。SVC-CI预测容量反应的ROC曲线下面积为0.816（95%CI 0.673～0.958），敏感性85%，特异性75%。SVV预测容量反应的ROC曲线下面积为0.731（95%CI 0.567～0.895），敏感性55%，特异性88%。
结论 SVC-CI和SVV均可预测机械通气患者容量反应，而SVC-CI的预测效能优于SVV。 |
| 英文摘要: |
Objective To investigate whether the superior vena cava collapsibility index (SVC-CI) predicts fluid responsiveness in mechanically ventilated patients.
Methods Thirty-six patients, 20 males and 16 females, aged 18-64 years, ASA physical status Ⅰ or Ⅱ and NYHA class Ⅰ or Ⅱ, who underwent selective operation under general anesthesia were enrolled. All patients received Ringer’s lactate solution 10 ml/kg for 10-15 minutes. The data including MAP, HR, CVP, CI, SVV, SVC were recorded before and after fluid challenge. SVC was measured by transesophageal echocardiography while CI and SVV were recorded using FloTrac/Vigileo technology. Patients were separated into responders (ΔCI ≥ 15% after fluid challenge in group R) and non-responders (ΔCI < 15% in group NR). Receiver operating characteristic (ROC) curve analysis was used to assess the accuracy and cut-off of SVC-CI and SVV to predict fluid responsiveness.
Results There were 20 responders and 16 non-responders. The baseline SVC-CI was significantly higher in group R than in group NR (P < 0.05). The area under the ROC curve of SVC-CI was 0.816 (95% CI 0.673-0.958) with a sensitivity of 85% and a specificity of 75%, respectively. The area under the ROC curve of SVV was 0.731 (95% CI 0.567-0.895) and the sensitivity of SVV was only 55%, the specificity was 88%.
Conclusion The superior vena cava collapsibility (SVC-CI) and SVV can be used to predict fluid responsiveness in mechanically ventilated patients. And SVC-CI was superior in predicting fluid responsiveness compared with SVV. |
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