人工气腹下每搏量变异度及脉搏灌注指数变异用于血容量状况监测的价值

The clinical value of stroke volume variation and pleth variability index in predicting fluid responsiveness during increased intra-abdominal pressure

目的探讨人工气腹状态下每搏量变异度及脉搏灌注指数变异监测容量状态的准确性及诊断阈值。方法选择拟在全麻下行腹腔镜胃癌根治术的患者28例，全麻后连续监测每搏量变异度（SVV）、脉搏灌注指数变异（PVI）等血流动力学指标，人工气腹后进行容量负荷试验，记录输液前后各血流动力学指标数值，以输液后△每搏量变异指数（ASVI）是否≥15％，将患者分为对容量治疗有反应组（R组）和无反应组（NR）组，绘制SVV和PVI判断扩容效应的受试者工作特征性（ROC）曲线，确定人工气腹下SVV和PVI预测容量状况的准确性、诊断阌值及两者的相关性。结果SVV和PVI判断扩容有效的ROC曲线下面积分别为0．981和0．939，SVV的诊断阈值为9．5％，PVI的诊断阈值为14．0％，两者的相关性较好（r=0．74，P〈0．01）。结论SVV和PVI均能准确预测人工气腹下全麻机械通气患者的容量状况，二者预测容量状况的准确性相似，但两者的诊断阈值较正常腹压时相比均有所降低。

Objective To evaluate the abilities and thresholds of stroke volume variation （SVV） and pleth variability index （PVI） in predicting fluid responsiveness during increased intra-abdominal pressure. Methods 28 patients undergoing laparoscopy-assisted radical gastrectomy were selected. PVI was continuously displayed by the Masimo. Radical 7. All patients were also monitored with Vigileo/FloTrac system. Haemodynamic data such as MAP, HR, SVI, SVV, PI,PVI and CVP were recorded before and after volume expansion（ HES 6% ,7ml/kg）. Fluid respon-siveness was defined as an increase in SVI≥15% （A SVI ≥15）. Results The SVV threshold of 9.5% before volume expansion was able to diserimihate the responders from the non - responders with a sensitivity of 100% , and a specificity of 63.6%. The threshold for PVI was 14.0% ,the sensitivity of 100% and specificity of 81.8% were obtained. There was no significant difference between the area under the receiver operating characteristics （ROC） curves of SVV and PVI（0. 981,0. 939, respectively） , and there was significant correlation between the baseline SVV and the baseline PVI （r = 0. 740, P 〈 0.01 ）. Conclusion SVV and PVI can predict fluid responsiveness accurately during increased intra-abdominal pressure, the baseline SVV is correlated well with baseline PVI, and the ability of SVV and PVI in predicting fluid responsiveness is similar.