肺叶切除术患者不同通气模式下每搏量变异度的变化

Changes in stroke volume variation monitored by,FloTrac/Vigileo system during mechanical ventilation in patients undergoing pulmonary lobectomy

目的探讨肺叶切除术患者不同通气模式下每搏量变异度（SVV）的变化。方法择期行肺叶切除术患者44例，年龄44～64岁，体重47～86kg，ASA分级Ⅰ或Ⅱ级。采用noTrac压力换能器及Vigileo心输出量监测仪持续监测CI、每搏量指数（SVI）和SVV。术中补液速率6．8ml·kg^-1·h^-1（晶胶比1：1）维持血容量。于仰卧位双肺通气5min（T1）、侧卧位双肺通气2min（T2）、单肺通气开胸前（T3）、单肺通气开胸后5min（T4）、50min（T5）、单肺通气＋PEEP5cmH2O1min（T6）、15min（T7）、肺复张前（T8）、肺复张即刻（T9）和肺复张后1min（T10）时记录SVV、CI和SVI。SVV〈13％为正常值。结果患者术中血液动力学平稳，CI和SVI均在正常范围内波动。T9时SVV〉13％，其余各时间点均〈13％。SVVT2，3之间差异无统计学意义，T5～7之间差异均无统计学意义（P〉0．05）；T9时SVV较T8．10时升高（P〈0．01）。结论肺叶切除术中，单肺通气以及单肺通气联合PEEP5cmH10时SVV可用于指导液体治疗的判断，而在肺复张时SVV不能指导液体治疗。

Objective To investigate the changes in stroke volume variation （SVV） monitored by FloTrac/ Vigileo system during mechanical ventilation in patients undergoing pulmonary lobectomy. Methods Forty：four ASA Ⅰ or Ⅱ patients aged 44-64 yr weighing 47-86 kg undergoing elective pulmonary lobectomy performed under general anesthesia were studied. Blood volume was maintained by fluid （ crystalloid ： colloid 1 ： 1 ） infusion at a rate of 6-8 ml. kg-1.h-1. Cardiac output index （CI）, stroke volume index （SVI） and SVV were measured based on arterial pressure wave form analysis by FloTrac/Vigileo System （Edwards Co. , USA） and recorded at following time points： at 5 min of two-lung ventilation （TLV） in supine position, 2 min TLV in lateral position, during one-lung ventilation （OLV） before thoracotomy, at 5 and 30 min of OLV after thoracotomy, 1 and 15 rain OLV ＋ PEEP of 5 em H：2O, before and immediately and 1 rain after reflation of the remaining lobes. The normal value for SVV is less than 13% .Results The hemodynamic parameters were stable during lobeetomy. CI and SVI were within normal range. SVV was less than 13% at all time points except that at immediately after reflation of the remaining lobes. Conclusion SVV obtained with FloTrac/Vigileo system can be used to guide fluid therapy during OLV in mechan- ically ventilated patients undergoing pulmonary lobectomy.