摘要
目的探讨全身麻醉（全麻）不同潮气量（VT）下脉搏灌注指数变异（PVI）预示容量反应性的可行性。方法择期静脉复合全麻下子宫肌瘤手术患者60例均分为三组,分别实施VT为6、8和10ml/kg机械通气。记录20min内输入6%羟乙基淀粉500ml前后CVP、PVI、每搏变异度（SVV）和MAP,以心指数变化≥15%为指标将三组再分为容量有反应组（R组）和容量无反应组（NR组）。采用ROC曲线分析,计算其预示容量反应性的灵敏度和特异度。结果 VT8ml/kg组PVI预示容量反应性的灵敏度和特异度为84.6%和85.7%[95%CI（0.841~1.000）],VT10ml/kg组为83.6%和82.1%[95%CI（0.803~1.000）],均高于VT6ml/kg组的56.5%和50.0%[95%CI（0.288~0.822）]。VT8ml/kg和VT10ml/kg两组PVI及SVV的AUC均大于MAP及CVP。结论与VT6ml/kg比较,VT8ml/kg或VT10ml/kg通气时PVI预示容量反应性的价值较大。
Objective To investigate the feasibility of pleth variability index（PVI） in predicting fluid responsiveness under different tidal volumes （VT） during general anesthesia. Methods Sixty patients with hysteromyoma undergoing selective surgery under general anesthesia were divided into three groups of A（ventilated with VT 6 ml/kg） ,B（ventilated with VT 8 ml/kg） and C（ventilated with VT 10 ml/kg）. 6% Hetastarch 500 mililiters were infused in 20 minutes after stable stage of anesthesia induction. The CVP, PVI, SVV and MAP were recorded before and at 3 minutes after hetastarch infusion. ACI value was calculated. ACI^15% was defined as responsive to volume loading, by which each group was subdivided into two groups of R（responsive to volume loading） and NR （non- responsive to volume loading）. The ROC curve analysis was performed for calculating the sensibility and specificity of retative indicator in predicting fluid responsiveness under different tidal volumes. Results The sensibility and specificity of PVI in predicting fluid responsiveness in group B were 84.6% and 85.7%[-95%CI （0. 841-1. 000）] and those in group C were 83.6% and 82.1%[95%CI （0. 803-1. 000）],which were all higher than 56.5% and 50.0% in group A[95%CI （0. 288-0. 822）]. The areas under ROC curve of PVI and SVV were more than those of MAP and CVP in groups of B and C. Conclusion The value of PVI under ventilation with VT 8 ml/kg and VT 10 ml/kg is more than that with VT 6 ml/kg in predicting fluid responsiveness.
出处
《江苏医药》
CAS
2017年第19期1406-1408,1411,共4页
Jiangsu Medical Journal
