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| 潮气量负荷试验评估单肺通气患者容量反应性 |
| Tidal volume challenge evaluate fluid responsiveness during one-lung ventilation |
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| DOI：10.12089/jca.2022.07.001 |
| 中文关键词: 潮气量负荷试验 单肺通气 容量反应性 每搏量 |
| 英文关键词: Tidal volume challenge One-lung ventilation Fluid responsiveness Stroke volume |
| 基金项目:国家自然科学基金（82172190）；江苏省卫生健康委员会医学科研项目面上项目（M2021105） |
| 作者 | 单位 | E-mail | | 张嘉桐 | 225001,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | | | 张扬 | 225001,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | | | 杨柳青 | 225001,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | | | 孙思阳 | 225001,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | | | 高巨 | 225001,扬州大学临床医学院,江苏省苏北人民医院麻醉科 | doctor2227@163.com |
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| 中文摘要: |
目的 探讨潮气量负荷试验（VT C）时的血流动力学变化在评估单肺通气（OLV）容量反应性中的价值。
方法 选择择期全身麻醉下行胸腔镜手术患者58例，男25例，女33例，年龄18～64岁，BMI 18～25 kg/m 2，ASA Ⅰ—Ⅲ级。记录OLV 15 min时（VT C前）、VT C后2 min（VT C后）、VT调回5 ml/kg后2 min[容量负荷试验(VLT)前]和VLT后HR、MAP，应用经食管超声心动图（TEE）测量并记录上述4个时点的食管中段切面左心室流出道（LVOT）直径、胃底长轴切面主动脉瓣速度时间积分（VTI）和每搏量（SV），并计算VT C 前后SV相对变化率（ΔSV-VT C）、VT C 前后VTI相对变化率（ΔVTI-VT C）、VT C 前后MAP相对变化率（ΔMAP-VT C）和VLT前后SV相对变化率（ΔSV-VLT）。根据ΔSV-VLT将患者分为两组：容量反应性阳性组（R组，ΔSV-VLT≥10%）和容量反应性阴性组（NR组，ΔSV-VLT＜10%）。绘制各指标的受试者工作特征（ROC）曲线,计算曲线下面积(AUC)评估患者容量反应性。
结果 最终32例（55%）患者容量反应性阳性。ΔSV-VT C的AUC为0.81（95%CI 0.68～0.90），诊断界值为-16.1%，敏感性、特异性分别为78.1%、84.6%。ΔVTI-VT C的AUC为0.79（95%CI 0.66～0.89），诊断界值为-14.5%，敏感性、特异性分别为78.1%、80.8%。ΔMAP-VT C的AUC为0.56（95%CI 0.42～0.69），诊断界值为-5.1%，敏感性、特异性分别为53.1%、65.4%。
结论 潮气量负荷试验诱导的SV、VTI相对变化率能够预测单肺通气患者的容量反应性。 |
| 英文摘要: |
Objective To explore the value of hemodynamic changes induced by the tidal volume challenge (VT C) in assessing the fluid responsiveness during one-lung ventilation (OLV).
Methods Fifty-eight patients, 25 males and 33 females, aged 18-64 years, BMI 18-25 kg/m 2, ASA physical status Ⅰ-Ⅲ, were selected for thoracoscopic OLV surgery under general anesthesia. HR and MAP were recorded at OLV 15 minutes (before VT C), 2 minutes after performing VT C (after VT C), 2 minutes after adjusting VT back to 5 ml/kg [before volume-load test (VLT)] and after VLT. Transesophageal echocardiography (TEE) was used to measure and record the patient's left ventricular outflow tract (LVOT) diameter in mid-esophageal view, aortic valve velocity time integral (VTI) in long-axis view of the fundus and stroke volume (SV) at the above four time points. The relative change in SV before and after VT C (ΔSV-VT C), relative change in VTI before and after VT C (ΔVTI-VT C), relative change in MAP before and after VT C (ΔMAP-VT C), and relative change in SV before and after volume loading test (ΔSV-VLT) were calculated. Patients were divided into two groups according to ΔSV-VLT: responders (group R, ΔSV-VLT ≥ 10%) and non-responders (group NR,ΔSV-VLT < 10%). Receiver operating characteristic (ROC) curves for each indicator were generated, and the area under the curve (AUC) were calculated to evaluate the ability to discriminate the fluid responders from the nonresponders.
Results There were 32 responders (55%). AUC for ΔSV-VT C to discriminate responders from nonresponders were 0.81 (95% CI 0.68-0.90). The best threshold for ΔSV-VT C was -16.1%, with a sensitivity of 78.1% and a specificity of 84.6%. AUC for ΔVTI-VT C to discriminate the responders from the nonresponders were 0.79 (95% CI 0.66-0.89). The best threshold for ΔVTI-VT C was -14.5%, with a sensitivity of 78.1% and a specificity of 80.8%. AUC for ΔMAP-VT C to discriminate responders from nonresponders were 0.56 (95% CI 0.42-0.69). The best threshold for ΔMAP-VT C was -5.1%, with a sensitivity of 53.1% and a specificity of 65.4%.
Conclusion Tidal volume challenge induced relative changes of SV, VTI can predict fluid responsiveness in patients during one-lung ventilation. |
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