文章摘要
小剂量液体冲击试验时每搏量变化率对全身麻醉患儿容量反应性的预测价值
Predictive value of stroke volume change during mini-fluid challenge test for fluid responsiveness in pediatric patients under general anesthesia
  
DOI：10.12089/jca.2026.07.008
中文关键词: 全身麻醉  小剂量液体冲击试验  容量反应性  机械通气  每搏输出量
英文关键词: General anesthesia  Mini-fluid challenge test  Fluid responsiveness  Mechanical ventilation  Stroke volume
基金项目:
作者单位E-mail
郑雪梅 611731,成都市,电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院成人重症医学科  
叶海燕 611731,成都市,电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院成人重症医学科  
冉隆青 611731,成都市,电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院麻醉科  
伍孟军 611731,成都市,电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院麻醉科  
李波 611731,成都市,电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院成人重症医学科 13408039256@163.com 
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中文摘要:
      
目的：探讨小剂量液体冲击试验预测择期全身麻醉手术患儿容量反应性的价值。
方法：选择择期全身麻醉手术患儿，年龄2～6岁，ASA Ⅰ或Ⅱ级。采用经胸超声心动图，监测气管插管后3 min（T1），气管插管后5 min（T2），以0.3 ml·kg-1·min-1输注复方乳酸钠1 ml/kg结束后1 min（T3），以相同速率继续输注复方乳酸钠2 ml/kg（历时约6.7 min）结束后1 min（T4）时的HR、SBP、DBP、心输出量（CO）、左心室流出道速度时间积分（VTI）、每搏输出量（SV）。计算T3时相对于T2时SV的变化率（ΔSV3）和T4时相对于T2时SV的变化率（ΔSV4），以ΔSV4≥10%定义为容量反应性试验阳性，将患儿分为有容量反应组（Rs组）和无容量反应组（NRs组）。采用受试者工作特征曲线（ROC）评估ΔSV预测容量反应性的效能,计算曲线下面积（AUC）。
结果：共纳入患儿44例，Rs组26例，NRs组18例。与NRs组比较，Rs组T2—T4时SV明显降低，T2时CO明显降低，T3时VTI明显升高（P＜0.05）。T4时两组HR、SBP、DBP差异无统计学意义。ΔSV3 判断容量反应性的AUC为0.842（95%CI 0.68～1.00，P＜0.001），敏感性为0.842，特异性为0.857。
结论：复方乳酸钠1 ml/kg液体冲击试验中,每搏输出量变化率(ΔSV)可预测择期全身麻醉手术患儿的容量反应性。
英文摘要:
      
Objective: To investigate the predictive value of mini-fluid challenge test variability for fluid responsiveness in children undergoing elective general anesthesia surgery.
Methods: Children aged 2-6 years, classified as ASA physical status Ⅰ or Ⅱ, scheduled for elective surgery under general anesthesia were enrolled. Transthoracic echocardiography was used to monitor HR,SBP,DBP,cardiac output (CO), left ventricular outflow tract velocity-time integral (VTI), and stroke volume (SV) at the following time points: 3 minutes after endotracheal intubation (T1), 5 minutes after intubation (T2), 1 minute after completing a 1 ml/kg infusion of compound sodium lactate at 0.3 ml·kg-1·min-1 (T3), and 1 minute after completing a subsequent 2 ml/kg infusion at the same rate (T4). The interval between T3 and T4 was approximately 7-8 minutes. The change rate of SV at T3 relative to T2 (ΔSV3) and at T4 relative to T2 (ΔSV4) were calculated. Fluid responsiveness was defined as a ΔSV4 ≥ 10%, and patients were accordingly divided into a responder group (group Rs) and a non-responder group (group NRs). Receiver operating characteristic (ROC) curves were used to evaluate the performance of ΔSV in predicting fluid responsiveness, and the area under the curve (AUC) was calculated.
Results: Forty-four children were enrolled, with 26 in group Rs and 18 in group NRs. Compared with group NRs, the SV in group Rs was significantly lower at T2-T4, the CO was significantly lower at T2, and the VTI was significantly higher at T3 (P < 0.05). There was no statistically significant difference in HR, SBP, and DBP between the two groups at T4. The AUC of ΔSV3 for predicting fluid responsiveness was 0.842 (95% CI 0.68-1.00, P < 0.001), with a sensitivity of 0.842 and a specificity of 0.857.
Conclusion: The stroke volume change rate (ΔSV) during a 1 ml/kg compound sodium lactate mini-fluid challenge predicts fluid responsiveness in children undergoing elective surgery under general anesthesia.
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