平均动脉压和尿液指标对全麻患者容量反应性的预测价值

Role of mean arterial pressure and urine parameter as an indicator of fluid responsiveness in patients during general anesthesia

目的探讨尿液指标或平均动脉压(MAP)对全麻患者容量反应性的预测作用。方法择期全麻下胃肠肿瘤手术患者56例,ASAⅠ~Ⅱ。麻醉诱导后10 min予以连续3次容量负荷(3 ml/kg),根据每搏心输出量指数(SVI)定义容量有反应(SVI增加≥10%)或无反应(SVI增加<10%)。并根据对容量有反应需要容量负荷的次数分成2组:1次(Ⅰ组)和2~3次(Ⅱ组)。结果Ⅱ组患者术前尿渗透压、尿肌酐浓度和尿比重均高于Ⅰ组(P<0.05)。而麻醉前、麻醉诱导气管插管以及容量负荷期间,2组患者的MAP均相当(P>0.05)。受试者工作曲线(ROC)表明:以尿肌酐≥12 mmol/L为阈值判断是否有容量反应性,AUC为0.69(P=0.021);以心脏指数(CI)≤3.5 L/(min·m^2)为阈值判断是否有容量反应性,AUC为0.65(P=0.027)。将尿肌酐和CI结合起来预测容量反应性,AUC为0.85(P=0.001),敏感度为86%,特异性为91%。结论尿液指标可以预测全麻患者容量反应性,联合CI可提高预测准确性;而MAP没有预测作用。

Objective To explore the indicate role of urine index or MAP of fluid responsiveness for patients during general anesthesia. Methods Fifty-six patients with ASA physical status Ⅰ- Ⅱ scheduled for gastro intestinal （GI） cancer surgery. Three times of bolus infusion （3 ml/kg） were administered 10min after induction of anesthesia. Responsiveness was defined if stroke volume inder（SVI） increased by ≥ 10% from the bolus infusion; while SVI 〈 10% was unrespons- iveness. And according to the numbers of boluses warranted, all patients were divided into two groups ： Group Ⅰ （ one bo- lus warranted） and Group Ⅱ （two - three boluses warranted）. Results Patients in Group Ⅱ have higher urinary os- molality, creatinine（Cr） concentration, and specific gravity at baseline compared with those in Group I （P 〈 0.05）. MAP in baseline, during induction anesthesia and intubation, and during 3 boluses of fluid was nearly identical between two groups （P 〉 0. 05 ）. The receiver-operating characteristic （ROC） curve demonstrated that the threshold value of urinary Cr ≥12 mmol/L for prediction of fluid responsiveness revealed the area under the curve （AUC） of 0.69 （P = 0. 021 ）, and cardiac inder （ CI of ≤ 3.5 L/（ min· m2 ） revealed AUC of 0.65 （ P = 0. 027 ）. Urinary Cr in combination with CI for pre- diction of fluid responsiveness showed an AUC of 0.85 （P =0. 001 ） with a sensitivity of 86% and a specificity of 91%. Conclusion Urinary parameters can be used as an indicator of fluid responsiveness in patients during general anesthesia. Combination of both criteria of Cr and Urinary CI improve the accuracy of prediction, but MAP cannot be used as an indicator of fluid responsiveness.