气腹下动脉收缩压变异度的下降成分预测容量反应的准确性

A decreasing component of arterial systolic pressure variability predicts the accuracy of thevolumetric response in pneumoperitoneum

目的评价气腹下动脉收缩压变异度(SPV)的下降成分(Ddown)预测容量反应的准确性。方法择期行腹腔镜胃癌根治术的患者40例,年龄50~70岁,性别不限,BMI 19~25kg/m^2,ASA分级Ⅰ或Ⅱ级。麻醉诱导并建立气腹后(T1)记录HR、MAP、心输出量(CO)、心脏指数(CI)、每搏量指数(SVI)、每搏量变异度(SVV)并测量动脉收缩压变异性(SPV)的下降成分Ddown。在15min内输注6%羟乙基淀粉130/0.4氯化钠溶液500ml,5min后(T2)再次记录上述指标,以输液后SVI增高是否≥10%将患者分为容量反应阳性组(n=18)和容量反应阴性组(n=16)。绘制Ddown和SVV的ROC曲线。结果Ddown和SVV的曲线下面积(95%可信区间)分别是0.98(0.95-1.00)及0.95(0.88-1.00)。结论气腹下,动脉收缩压变异度的Ddown可准确监测患者血容量的变化。

Objective To evaluate the accuracy of delta down(Ddown),a decreasing component of arterial systolic pressure variability(SPV),in predicting volume response under laparoscopic surgery.Methods Forty gastric cancer patients undergoing laparoscopic radical gastrectomy were enrolled,aged from 50~70 yr,with no gender limitation,BMI 19~25kg/m2,and ASA grade I or II.After induction of general anesthesia and establishment of pneumoperitoneum(T1),HR,MAP,cardiac output(CO),cardiac index(CI),stroke volume index(SVI)and stroke volume variability(SVV)were recorded,Ddown was calculated.Then 500ml of 6%hydroxyethyl starch(HES 130/0.4)was infused over 15min,and recorded the above indexes again after 5min.The patients were divided into volume reaction positive group(n=18)and volume reaction negative group(n=16)according to whether the increase of SVI was≥10%after infusion.The ROC curves of Ddown and SVV were drawn.Results The area under the curve(95%confidence interval)of Ddown and SVV was 0.98(0.95-1.00)and 0.95(0.88-1.00)respectively.Conclusion Under pneumoperitone-um,the variability of Ddown in arterial systolic pressure can accurately monitor the changes of blood volume in patients.