颈动脉峰值流速变异率评估腹腔镜手术患者容量反应性的价值

Vadilidation of respirophasic variation in carotid artery blood flow peak velocity as predictors of fluid responsiveness in patients undergoing laparoscopic surgery

目的探讨颈动脉峰值流速变异率(respirophasic variation in carotid artery blood flow peak velocity,ΔVpeak-CA)评估腹腔镜手术患者容量反应性的准确性和可行性。方法选择择期行腹腔镜下手术患者55例,男29例,女26例,年龄45~75岁,BMI 20~24 kg/m2,ASAⅠ~Ⅲ级。在气腹压稳定于13~15 mm Hg后,20 min内快速静脉输注羟乙基淀粉130/0.4氯化钠注射液7 ml/kg。以心脏指数(cardiac index,CI)的增长量(ΔCI)≥15%作为液体反应阳性的判定标准,分为有反应组(R组,n=32)和无反应组(NR组,n=23),并绘制ΔVpeak-CA判断容量变化的受试者工作特性曲线(receiver operating characteristic curve,ROC),计算诊断阈值、曲线下面积(area under curve,AUC)和95%可信区间(CI)。记录麻醉诱导后5 min(气腹前,T1)、气腹压上调稳定于13~15 mm Hg5 min后(T2)、补液后5 min(T3)的每博变异率(SVV)、ΔVpeak-CA和CI。结果气腹下补液前ΔVpeak-CA与CI呈高度负相关(r=-0.843,P<0.001)。ΔVpeak-CA评估容量反应性的ROC曲线的AUC为0.884(95%CI 0.793~0.975),诊断阈值为17.85%,判断液体反应性的灵敏度为81.3%,特异度为91.3%。结论ΔVpeak-CA可作为腹腔镜手术患者评估容量反应性的可靠指标。

Objective To assess the accuracy and feasibility of respirophasic variation in carotid artery blood flow peak velocity （AVpeak-CA） as predictors of fluid responsiveness in laparoscopic surgery. Methods Fifty-five patients undergoing laparoscopic surgeries, 29 males and 26 females, aged 45-75 years, ASA physical statusⅠ-Ⅲ, with body mass index 20-24 kg/mz, were enrolled. When intra-abdominal pressure was steady at the level of 13-15 mm Hg, 6% hydroxyethylstarch （HES 130/0. 4） 500 ml was infused at the speed of 7 ml/kg within 20 minutes. After volume expan- sion, subjects were classified as responders （group R, n=32） if cardiac index increased （ACI） was≥15% and no responders （group NR, n = 23） as △CI〈15%. The receiver operating characteristic curve （ROC） curve for AVpeak-CA in determining the volume expansion responsiveness was plotted, and the diagnostic threshold was determined. The area under curve （AUC） and 95 % confidence inter- val （CI） was calculated. Cardiac index （CI）, AVpeak-CA and stroke volume variation （SVV） were independently recorded at 5 minutes after induction （T1）, 5 minutes after intra-abdominal pressure were stable at the level of 13-15 rnm Hg （T2） and 5 minutes after volume expansion （T3）. Results AVpeak-CA is highly negatively correlated with CI （r=-0. 843, P%0. 001）. The results of ROC curve analysis showed, AVpeak-CA threshold discriminated between responders and non-re- sponders with a sensitivity of 81.3% and a specificity of 91.3%, and the AUC was 0. 884 （95% CI 0. 793-0. 975）. Conclusion AVpeak-CA seems to be a highly feasible and reliable predictor for fluid responsiveness in laparoscopic surgery patients.