经食管超声多普勒血液动力学指标监测患者血容量变化的准确性

Accuracy of hemodynamic parameters by transesophageal echocardiography for monitoring the blood volume in patients

目的 通过与中心静脉压（CVP）监测比较，评价经食管超声多普勒血液动力学指标监测患者血容量变化的准确性。方法 择期行肝癌切除术男性患者40例，年龄40-50岁，ASAⅡ级，麻醉诱导后至术前经静脉输注6％羟乙基淀粉（HES 130／0．4）0．67 ml·kg^-1·min^-1，分别在输注前、输注胶体液剂量达2、4、6、8、10 ml／kg时采用经食管超声多普勒监测仪监测校正左室射血时间（LVETc）、心输出量（CO）、每搏量（SV）、心指数（CI）、每搏指数（SI），并行右颈内静脉穿刺置管监测同时点CVP。结果 各血液动力学指标与胶体液输注剂量之间的等级相关系数分别为：rLVETc=0．981±0．012，rCO= 0．800±0．042，rSV=0．813±0．025，rCI=0．790±0．022，rSI=0．787±0．023，rCVP=0．903±0．025;rLVETc最高，而与rCVP相比，rCO、rSV、rCI及rSI较低（P〈0．05）。结论 经食管超声多普勒血液动力学指标LVETc、CO、SV、CI及SI均可用于血容量监测，其中LVETc的准确性最高，且高于CVP监测。

Objective To evaluate the accuracy of the hemodynamic indexes by transesophageal echocardiography for monitoring blood volume in comparison with CVP. Methods Forty ASA Ⅱ male patients aged 40-50 yr scheduled for elective hepatic carcinectomy were studied. Anesthesia was induced with intravenous fentanyl 4 μg/kg and target-controlled infusion of propofol at plasma concentration of 3 μg/ml. When BIS was below 50, rocuronium 0.6 mg/kg was administered i.v. and tracheal intubation was facilitated after TOF ratio of 0 being achieved. Anesthesia was maintained with TCI of propofol and intermittent boluses of rocuronium to keep BIS of 45- 50 and TOF ratio of 0 under mechanical ventilation. The right internal jugular vein was cannulated for central venous pressure （CVP） monitoring. 6 % hydroxyethyl starch （HES 130/0.4） was intermittently infused i.v. at the rate of 0.67 ml·kg^- 1· min^- 1 following anesthesia to reach the consecutive cumulative-dose of 2, 4, 6, 8 and 10 ml/kg. Hemosonic-100 transesophageal Doppler echocardiographic monitor was used to measure the corrected left ventricular ejection time （LVETc）, cardiac output （CO）, stroke volume （SV）, cardiac index （CI）, stroke volume index （SI） immediately before the infusion and at reaching different cumulative-doses respectively and CVP was recorded simultaneously. Results The rank correlation coefficients between every hemodynamic parameter above and the cumulative-doses were as followed： rLVETc = 0.981 ± 0.012, rCVP = 0.903 ± 0.025, rSV = 0.813 ± 0.025, rCO = 0.800 ± 0.042, rCI = 0.790 ± 0.022, rSI = 0.787 ± 0.023. rLVETc was significantly higher than any other correlation coefficients, rcve was significantly higher than rSV, rCO, rCI and rSI （ P 〈 0.05）. Conclusion The hemodynamic variables by transesophageal echocardiography, LVETc, CO, SV, CI and SI, can be applicable to blood volume monitoring, among which LVETc achieves the highest accuracy, what is more, the accuracy of LVETc is higher than that of conventional CVP.