收缩压变异率监测患者血容量变化的准确性

Accuracy of systolic pressure variation in monitoring blood volume

目的评价收缩压变异率（SPV）监测患者血容量变化的准确性。方法择期行体外循环下冠状动脉旁路移植术患者22例，男性17例，女性5例，年龄49～79岁，身高153～173cm，体重55～89kg，体表指数1．53～2．00m2，ASA分级Ⅱ或Ⅲ级，采用经外周动脉压力波形分析技术监测每搏量变异率（SVV）和有创动脉波形监测更改标名后计算SPV。关胸后立即进行容量负荷试验，颈内静脉输注6％羟乙基淀粉130／0．450～80ml／min，直至心指数（CI）增加10％时停止输注。分别于切皮前平卧位（T1）、切皮前头低30°（T1＇）、平卧位开胸前（T2）、开胸后（T2’）、关胸后平卧位容量负荷试验前（T1）、容量负荷试验后（T1’）、缝皮后平卧位（T4）、缝皮后头低30°（T4’）时记录HR、MAP、SPV、CI、SVV、每搏指数（SVI）、体循环血管阻力指数（SVRI）、CVP和肺毛细血管楔压（PCWP）。计算T1’与，T1、T2’与T2、T3’与T3及T4’与T4时SVV的差值（△SVV）和SPV的差值（△SPV），绘制△SVV和△SPV判断血容量变化的受试者工作特性曲线。结果与T1时比较，T1’时MAP、CVP、PCWP、CI和SVRI升高，SVV和SPV降低（P〈0．05）；与T2时比较，T2’时HR升高，CVP降低（P〈0．05）；与T3时比较，T3’时MAP、CVP、PCWP和CI升高，SVV和SPV降低（P〈0．05）；与T4时比较，T4’时MAP、CVP和PCWP升高，SVV和SPV降低（P〈0．05）。△SVV和△SPV判断血容量变化的受试者工作特性曲线下面积分别为0．603和0．616，差异无统计学意义（P〉0．05）。结论SPV可准确地监测患者血容量变化。

Objective To evaluate the accuracy of systolic pressure variation （SPV） in monitoring blood volume in patients. Methods Twenty-two ASA II or III patients （ 17 male, 5 female）, aged 49-79 yr, with body height 153-173 cm, weighing 55-89 kg, scheduled for elective coronary artery bypass grafting under cardiopulmo- nary bypass, were studied. Stroke volume variation （SVV） was monitored based on the arterial pressure wave and SPV measured based on the invasive arterial pressure wave after changing the title. After the chest was closed, the volume load test was immediately carried out. 6% hydroxyethyl starch 130/0.4 50-80 ml/min was infused via the jugular vein until cardiac index （CI） increased by 10% . HR, mean arterial pressure （MAP）, SPV, CI, SVV, stroke volume index （svi）, systemic vascular resistance index （SVRI）, central venous pressure （CVP） , and pul- monary capillary wedge pressure （PCWP） were recorded in supine position （T1）, at 30° head-down tilt before skin incision （T1 ＇）, before （T2） and after opening the chest in supine position （T2＇）, before （T3） and after the vol- ume load test in supine position after closing the chest （T3＇ ）, in supine position after skin closure （T4） , and at 30~ head-down tilt after skin closure （T4＇）. The difference in SPV and SVV （/x. SPV and A SVV） was calculated. The receiver operator characteristic curve for △SVV and △SPV in determining blood volume changes was plotted. Results MAP, CVP, PCWP, CI, and SVRI were significantly increased, while SVV and SPV were decreased at T1 ＇ compared with those at T1 （ P 〈 0.05）. HR was significantly increased, while CVP was decreased at T2＇ com- pared with those at T2 （ P 〈 0.05）. MAP, CVP, PCWP, and CI were significantly increased, while SVV and SPV were decreased at T3＇ compared with those at T3 （ P 〈 0.05 ）. MAP, CVP, and PCWP were significantly in- creased, while SVV and SPV were decreased at T4＇ compared with those at T4 （ P 〈 0.05 ）. The area under receive operator characteristic curve for △SVV and △SPV in determining blood volume changes was 0. 603 and 0. 616 re- spectively, and there was no significant difference （ P 〉 0.05）. Conclusion SPV can accurately monitor the blood volume in patients.