SVV、CVP和PAWP监测肾移植术患者容量变化准确性的比较

Comparison of accuracy of SVV, CVP and PAWP in monitoring changes in blood volume in patients undergoing renal transplantation

目的比较每搏量变异度（SVV）、中心静脉压（CVP）和肺动脉楔压（PAWP）监测肾移植术患者容量变化的准确性。方法择期全麻下行同种异体肾移植术的慢性肾衰患者16例，ASA分级Ⅱ或Ⅲ级，性别不限，年龄18～55岁，术中采用FloTrac/Vigileo监测仪监测SVV，采用肺动脉导管监测CVP、PAWP和每博量指数（SVI），于麻醉诱导后30 min、肾动脉开放前5 min、肾动脉开放后5、30 min和手术结束时记录血流动力学指标。麻醉诱导后30 min，经中心静脉导管15 min输注羟乙基淀粉130/0.4电解质注射液6 ml/kg进行液体反应性试验，以SVI变化≥15%作为液体反应阳性标准。CVP与SVV和PAWP进行Pearson相关分析。绘制CVP、SVV和PAWP判断容量变化的ROC曲线，计算曲线下面积（AUC）。结果与肾动脉开放前5 min时比较，肾动脉开放后SVV升高（P〈0.05），CVP和PAWP差异无统计学意义（P〉0.05）。SVV与CVP呈负相关，r＝－0.82（P〈0.01），SVV与PAWP呈负相关，r＝－0.77（P〈0.01）。SVV监测血容量变化的AUC为0.87，CVP和PAWP分别为0.69和0.66。结论SVV监测肾移植术患者容量变化的准确性优于CVP和PAWP。

Objective To compare the accuracy of stroke volume variation （SVV）, central venous pressure （CVP） and pulmonary arterial wedge pressure （PAWP） in monitoring the changes in blood volume in the patients undergoing renal transplantation. Methods Sixteen patients with chronic renal failure, of American Society of Anesthesiologists physical status ]] or Ill, aged 18-55 yr, scheduled for elective allograft renal transplantation under general anesthesia, were enrolled in the study. SVV was continuously monitored with the FloTrac/Vigileo monitor, and CVP, PAWP and stroke volume index （SVI） were continuously monitored with the volumetric pulmonary artery catheter during surgery. The parameters of hemodynamics were recorded at 30 min after induction of anesthesia, 5 min before renal artery opening, 5 and 30 rain after renal artery opening, and at the end of surgery, tiydroxyethyl starch 130/0.4 electrolyte solution 6 ml/kg was infused over 15 min via the central venous catheter to perform fluid responsiveness starting from 30 rain after induction of anesthesia. Positive fluid responsiveness was defined as the change in SVI 〉~ 15%. The relationship between SVV and CVP and between SVV and PAWP was analyzed using the Pearson correlation analysis. The receiver operating characteristic curve for CVP, SVV and PAWP in monitoring the changes in blood volume was drawn, and the area under the curve was calculated. Results Compared with the value at 5 min before renal artery opening, SVV was significantly increased after renal artery opening （P〈0.05） , and no significant change was found in CVP and PAWP after renal artery opening （P〉0.05）. SVV was negatively correlated with C VP, and r =-0.82 （P〈0.01） ; SVV was negatively correlated with PAWP, and r=-0.77 （P〈0.01）. The area under the curve of SVV in monitoring the changes in blood volume was 0.87, and of CVP and PAWP was 0.69 and 0.66, respectively. Conclusion SVV provides better accuracy than CVP and PAWP in monitoring the changes in blood volume in the patients undergoing renal transplantation.