中心静脉压联合每搏心输出量对全麻患者容量反应性的预测价值

Value of central venous pressure in combination with stroke volume in prediction of fluid responsiveness during general anesthesia

目的探讨中心静脉压(CVP)联合每搏心输出量(SV)对全麻患者容量反应性的预测价值。方法选择ASA Ⅰ~Ⅱ级胃肠外科肿瘤择期大手术患者80例,麻醉诱导后以6%羟乙基淀粉进行容量负荷,每次剂量3 ml/kg,连续3次。分别于麻醉前、每次容量负荷之前,应用Flo Trac/Vigileo监测SV和每搏心输出量变异(SVV),同时测量CVP值。容量负荷后患者的SV增加≥10%定义为容量负荷有反应性,此患者称作"有反应者";SV增加<10%的患者称作"无反应者"。结果对容量负荷无反应者的CVP值高于有反应者(7.2 mm Hg vs 5.6 mm Hg,P<0.01),无反应者中CVP值不变者对再次容量负荷有反应性的预测概率为48%;而CVP值升高者对容量负荷有反应性的预测概率为9%(P<0.01)。对于容量负荷反应性的判断,SV和SVV两种标准具有中等程度的一致性(Cohen's kappa系数0.28)。结论对于容量无反应的患者CVP可以作为辅助指标指导容量负荷。SVV与SV对于预测容量反应性存在一致性,但一致性程度不够理想。

Objective To assess the value of central venous pressure(CVP) combined with stroke volume(SV) in prediction of fluid responsiveness in patients during general anesthesia. Methods Eighty patients with ASA(American Society of Anesthesiologist) physical status Ⅰ-Ⅱ scheduled for major gastrointestinal cancer surgery were enrolled in the study. Three times of bolus infusion of 6% hydroxyethyl starch(130/0.4, Voluven) at a dose of 3 ml/kg were administered after induction of anesthesia. SV and SV variation(SVV) was monitored with Flo Trac/Vigileo and the CVP were measured immediately before general anesthesia was induced(baseline) and before each of three successive bolus infusions. Patients with SV increased by ≥10% from the bolus infusion were classified as responder and those with SV <10% were classified as non-responder. Results The CVP was higher in non-responders than that in responders(7.2 mm Hg vs 5.6 mm Hg, P<0.01). In non-responders, if no rise in CVP occurred, 48% would have subsequent fluid responsiveness, while in those with increased CVP, the chance was only 9%(P<0.01). There was only a fair concordance between SV and SVV as indicators of fluid responsiveness(Cohen's kappa=0.28).Conclusion CVP can serve as adjunct parameter for guiding the fluid responsiveness in patients with general anesthesia. There has certain consistency between SV and SVV in prediction of fluid responsiveness, but the degree of consistency was not satisfactory.