每搏量变异指数在单肺通气时预测输液反应的观察

Evaluation of stroke volume variation as a predictor of fluid responsiveness in patients undergoing one-lung ventilation

目的观察每搏量变异指数(SVV)在胸科手术单肺通气时预测输液反应的能力。方法择期行肺叶切除手术患者30例,麻醉后行桡动脉穿刺,连接FloTrac传感器(Vigileo监测仪),潮气量8ml/kg,单肺通气1h后,30min内快速输注6%羟乙基淀粉130/0.4氯化钠注射液(万汶)500ml,心排指数(CI)增加≥15%为容量治疗有反应。记录患者输液前及输液后的平均动脉压(MAP)、心率(HR)、心脏指数(CI)、每搏量指数(SVI)和SVV。结果有反应组16例,无反应组14例。有反应组输液前后CI、SVI明显增加(P<0.01),输液前后两组的SVV均无显著性差异(P>0.05)。SVV、CI和SVI的基础值与△CI无显著相关性(P>0.05)。结论在单肺通气的手术中,SVV不能有效预测输液反应,可能与开胸状态下胸内压改变有关。

Objective To investigate the ability of stroke volume variation（SVV） calculated by the Vigileo-FloTrac system to predict fluid responsiveness in patients undergoing one-lung ventilation（OLV）.Methods Thirty patients scheduled for a pulmonary lobectomy requiring OLV under general anesthesia.After starting OLV,500 ml hydroxyl-ethyl starch was administered within 30 minutes.Hemodynamic variables including heart rate,mean arterial pressure,cardiac index（CI）,stroke volume index（SVI）,and SVV were measured before and after volume loading.Results Of the 30 patients,16（53%） were responders to intravascular volume expansion（△CI ≥ 15%）,and 14（47%） were nonresponders（△CI 15%）.There were significant increases of CI,SVI in responders after volume expansion（P 0.01）,but there were no significant changes in SVV in responders and non-responders（P 0.05）.The baseline value of SVV,CI and SVI was not significantly correlated with △CI（P 0.05）.Conclusion SVV measured by the Vigileo-FloTrac system fails to predict fluid responsiveness in patients undergoing surgery with OLV.