颈动脉峰值流速变异率预测俯卧位手术患者容量反应性的准确性

Accuracy of respirophasic variation in carotid artery blood flow peak velocity in predicting fluid re-sponsiveness in patients undergoing surgery in prone position

目的评价颈动脉峰值流速变异率（△Vpeak-CA）预测俯卧位手术患者容量反应性的准确性。 方法择期行腰椎后路手术患者43例，年龄45～75岁，性别不限，BMI 20～25 kg/m2，ASA分级Ⅰ-Ⅲ级。麻醉诱导后，俯卧位状态下经20 min快速静脉输注羟乙基淀粉130/0.4氯化钠注射液7 ml/kg。以每搏指数升高幅度≥15%作为容量反应阳性标准，绘制△Vpeak-CA判断容量反应阳性的ROC曲线。 结果ROC曲线分析结果示：ΔVpeak-CA预测血容量反应性阳性的诊断阈值为7.94%时，灵敏度为81.8%，特异度为70.0%，曲线下面积（95%可信区间）为0.818（0.378～0.757）。 结论△Vpeak-CA可准确预测俯卧位手术患者容量反应性。

Objective To evaluate the accuracy of respirophasic variation in carotid artery blood flow peak velocity （△Vpeak-CA） in predicting fluid responsiveness in the patients undergoing surgery in the prone position. Methods Forty-three American Society of Anesthesiologists physical statusⅠ-Ⅲ pa- tients of both sexes, aged 45-75 yr, with body mass index of 20-25 kg/m2 , scheduled for elective posteri- or approach lumbar surgery, were enrolled in the study. After induction of anesthesia, hydroxyethyl starch 130/0.4 sodium chloride injection 7 ml/kg was intravenously infused over 20 min when the patients were in the prone position. Subjects were classified as responders if stroke volume index increased t〉 15% after vol- ume expansion. The receiver operating characteristic curve for AVpeak-CA in determining positive fluid re- sponsiveness was drawn. Results The results of receiver operating characteristic curve analysis showed that： the cut-off value of △Vpeak-CA in predicting positive fluid responsiveness was 7.94%, sensitivity 81.8%, specificity 70.0%, and the area under the curve （95% confidence interval） was 0. 818 （0. 378-0. 757）. Conclusion Respirophasic AVpeak-CA can accurately predict fluid responsiveness in the patients undergoing surgery in the prone position.