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| 颈动脉校正血流时间评估患儿容量反应性的有效性 |
| Efficacy of carotid corrected flow time predicting fluid responsiveness in children |
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| DOI：10.12089/jca.2022.11.006 |
| 中文关键词: 颈动脉校正血流时间 超声 儿童 容量监测 围术期 |
| 英文关键词: Carotid corrected flow time Ultrasounography Pediatrics Volume monitoring Perioperative period |
| 基金项目:深圳市科技计划面上项目（JCYJ20210324100206017）；深圳大学总医院科研培育项目（SUGH2019PY001） |
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| 中文摘要: |
目的 评估颈动脉校正血流时间（FTc）对患儿容量反应性的诊断价值。
方法 选择拟行腺样体扁桃体切除术患儿51例，男29例，女22例，年龄1～12岁，体重12～54 kg，ASA Ⅰ—Ⅲ级。麻醉诱导后进行补液试验（FC），根据患儿标准体重，静脉泵注生理盐水10 ml/kg，持续15 min。记录FC前即刻和FC后即刻HR、SBP、DBP、颈总动脉血流频谱图、经胸超声主动脉瓣血流频谱图，并测算上述时点的颈动脉FTc、主动脉瓣血流速度时间积分（VTI）和FC后即刻每博量（SV）较FC前即刻的变化率（%SV）。根据%SV是否≥10%，将患儿分为两组：具有容量反应性组（R组，%SV ≥10%）和无容量反应性组（NR组，%SV <10%）。绘制颈动脉FTc的受试者工作特征曲线，并计算曲线下面积（AUC），评估颈动脉FTc对患儿容量反应性的诊断价值。
结果 本研究最终具有容量反应性患儿32例（62.7%）。与FC前即刻比较，FC后即刻两组FTc明显延长、VTI明显升高（P＜0.001）。FC前即刻R组FTc明显短于、VTI明显低于NR组（P＜0.001），FC后即刻两组FTc和VTI差异无统计学意义。不同时点两组HR、SBP、DBP差异无统计学意义。颈动脉FTc诊断容量反应性的AUC为0.721（95%CI 0.578～0.865），截断值351.70 ms，敏感性56.3%，特异性84.2%。
结论 颈动脉FTc具有评估1～12岁患儿容量反应性的效力，可用于反映患儿围术期容量状况。 |
| 英文摘要: |
Ojective To investigate the predictive value of carotid corrected flow time (FTc) for pediatric fluid responsiveness.
Methods Children scheduled for elective otorhinolaryngologic surgery, 29 males and 22 females, aged 1-12 years, weight 12-54 kg, ASA physical statusⅠ-Ⅲ were included. After anesthesia induction, a fluid challenge (FC) of 10 ml/kg (standard body weight) of normal saline was continuously pumped within 15 minntes. HR, SBP, DBP, ultrasound images, including common carotid spectral doppler flow and left ventricular outflow tract spectral doppler flow measured using transthoracic echocardiography were recorded immediately before and after FC. Carotid FTc, aortic valve blood flow velocity time integral (VTI), and percent change in stroke volume (%SV) immediately after FC compared with immediately before FC were calculated based on the ultrasound images. According to whether %SV ≥ 10%, children were defined as volume responsive group (group R, %SV ≥ 10%) and non volume responsive group (group NR, %SV < 10%). Using the receiver operating characteristic curve and the area under the curve (AUC) to reflect the predictive value of carotid FTc.
Results Thirty-two (62.7%) showed a fluid response in the study. Compared with that immediately before FC, FTc and VTI in both groups were significantly increased immediately after FC (P < 0.001). FTc and VTI in group R were significantly lower than those in group NR immediately before FC (P < 0.001), and there was no significant difference between the two groups immediately after FC. There was no significant difference in HR, SBP, DBP between the two groups at different time points. The AUC of carotid FTc in the diagnosis of fluid responsiveness was 0.721 (95% CI 0.578-0.865), the cut-off value was 351.70 ms, the sensitivity was 56.3%, and the specificity was 84.2%.
Conclusion Carotid FTc showed predictive value for fluid responsiveness in children aged 1-12 years and could be used to reflect pediatric volume status. |
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