不同侧卧位对每搏量变异评估容量反应准确性的影响

The effect of lateral decubitus position on the abilities of stroke volume variation to predict fluid responsiveness

目的观察侧卧位对每搏量变异(SVV)的影响,评估侧卧位对于SVV判断容量反应准确性的影响。方法选择择期行侧卧位手术的患者52例,ASAⅠ或Ⅱ级,分为左侧卧位(L组)和右侧卧位组(R组),每组26例。常规全麻诱导后,予侧卧位后手术开始前进行容量负荷试验,以0.4ml·kg-1·min-1的速率输入6%羟乙基淀粉130/0.4氯化钠注射液7ml/kg。分别于全麻诱导插管后稳定10min(T1),将患者改为侧卧位稳定10min后(T2)、扩容3min后(T3)记录患者HR、MAP、SVV以及心脏指数(CI)。容量负荷阳性定义为容量负荷后CI增加≥15%为容量治疗有反应。结果与T1时比较,T2时两组SVV均明显降低(P<0.05)。与T2时比较,T3时两组HR明显减慢、SVV明显降低,MAP、CI明显升高(P<0.05)。49例患者为容量负荷阳性,3例为容量负荷阴性。容量负荷后所有阳性患者MAP以及CI明显升高(P<0.01),SVV明显降低(P<0.01)。L组SVV诊断阈值为10.5%,判断扩容有效的灵敏度为80.0%,特异度为72.7%;R组SVV的诊断阈值为10.5%,判断扩容有效的灵敏度为85.7%,特异度为83.3%。结论左侧卧位或右侧卧位时SVV判断血容量变化的准确性未受影响,准确性较高。

Objective To observe the effects of the lateral decubitus position during surgery on the stroke volume variation（SVV）.The aim of the study was to evaluate the ability of SVV to predict fluid response in mechanically ventilated patients in the lateral decubitus position during surgery.Methods Fifty two patients of ASA classⅠorⅡ,were randomly divided into left lateral decubitus position group（group L）and right lateral decubitus position group（group R）.Volume expansion were performed before operation with 6% hetastarch 7ml/kg at the rate of 0.4ml·kg-1·min-1.HR,MAP,SVV and cardiac output（CI）were all recorded at ten minutes after the induction of anaesthesia（T1）,10 min after patients changed to the lateral decubitus position（T2）and 3min after volume expansion（T3）.If CI increased 15%,the volume expansion was defined as responsive to volume expansion.Results Compared with T1,two groups of SVV were obviously decreased at T2（P〈0.05）.Compared with T2,HR and SVV in the two groups were decreased,MAP and CI were increased significantly（P〈0.05）.Three patients were not responsive to volume expansion and forty nine were responsive.MAP and CI increased signiflcantly after volume expansion（P〈0.01）,whereas SVV decreased signiflcantly after volume expansion（P〈0.01）.Fluid responsiveness was predicted in left lateral decubitus position by SVV 10.5%（sensitivity=80%,specificity=72.7%）.Fluid responsiveness was predicted in right lateral decubitus position by SVV 10.5%（sensitivity=85.7%,specificity=83.3%）.Conclusion The accuracy of SVV judgements blood volume changes were not affected in left lateral decubitus position ad right lateral decubitus position.