无创血流动力学监测在妇科阴式手术中的应用

The accuracy and thresholds of continuous noninvasive hemodynamic monitoring in vaginal surgery

目的探讨通过无创血流动力学监测的方法预测液体反应能力的准确性及阈值。方法选择妇科择期行阴式手术全麻患者20例。使用LiDCOrapid(CNAP)监测仪,分别于麻醉诱导前(T1)、插管后(T2)、容量试验(T3)记录HR、SBP、DBP、MAP、PPV、SVV、CO、SV、SVI等血流动力学指标。以输液后△SVI≥10%为阳性组,△SVI<10%为阴性组,绘制相关参数的受试者工作特征(receiver operation characteristic,ROC)曲线,计算曲线下面积(the area under the curves,AUC),评价SVV和PPV预测液体反应的能力。结果容量反应实验,SVV的ROC曲线下面积为0.76,诊断阈值为11%(灵敏度为85.7%,特异度为76.9%);PPV的ROC曲线面积为0.79,阈值为12%(灵敏度为85.7%,特异度为53.8%)。结论妇科阴式手术应用Li DCOrapid(CNAP)监测仪,所测的PPV和SVV有较好的预测液体反应能力。

Objective To validate the accuracy and thresholds of continuous noninvasive hemodynamic monitoring in predicting fluid responsiveness. Methods Twenty female patients undergoing selective vaginal surgery were en- rolled. Before the induction anesthesia, HR, SBP, DBP, MAP,PPV, SVV, CO , SV and SVI were recorded by the LiDCO rapid monitor when the circulation state became stable. After the induction anesthesia, HR, SBP, DBP, MAP, PPV, SVV, CO, SV and SVI were recorded again. Then the volume therapy was performed. Fluid positive responsiveness was defined as an increase in SVI≥10%. The ROC was used to assess the ability of each parameter to predict the fluid responsiveness. Results The AUCof SVV was 0.76, the threshold of SVV was ll%（Sensitivity 85.7%, Specificity 76.9%）, the AUC of PPV was 0.79, the threshold of PPV was12%（Sensitivity85.7%, Specificity 53.8%）. Conclusion SVV and PPV can predict fluid responsiveness accurately during vaginal surgery.