每搏量变异度评估不同心功能患者对容量负荷反应能力的研究

Study on the variation of stroke volume in prediction of responsiveness to fluid resuscitation in patients with different cardiac function

目的探讨每搏量变异度(SVV)在评估心功能不全患者和正常心功能患者中对容量负荷的反应能力有无差异。方法采用前瞻性研究方法,纳入首都医科大学附属北京友谊医院2015年1月至2016年5月择期行非停跳冠状动脉旁路移植术(CABG)的患者27例,腰椎管狭窄椎弓根钉内固定术患者25例,设为心功能异常组(A组)和心功能正常组(B组)。常规麻醉诱导后20 min连续恒速输注500 ml 6%羟乙基淀粉130/0.4氯化钠注射,观察记录输注液体前后SVV、每搏量(SV)、基于动脉压力波形的心排血量(APCO)、心率(HR)、平均动脉血压(MAP)。由Flo Trac/Vigileo系统计算获得容量负荷前后SV差值(△SV)≥10%为容量负荷后有反应,反之为无反应。结果容量负荷前后A组SVV及B组HR、SV、SVV比较差异有统计学意义(P<0.05);A组HR、MAP、APCO、SV前后比较差异无统计学意义(P>0.05);B组MAP、APCO前后比较差异无统计学意义(P>0.05)。两组反应性为:A组有反应者10例,无反应者17例;B组分别有反应者20例,无反应者5例。A组SVV基础值、△SVV(SVV变化值)与△SV(容量负荷前后SV差值)相关系数分别为:r1=0.436、r2=-0.542;B组的SVV基础值、△SVV与△SV的相关系数为:r1=0.454、r2=0.497;SVV基础值和△SVV与△SV存在直线负相关,两组回归直线差异无统计学意义(P>0.05)。结论每搏量变异度可以预测容量负荷反应能力,在心功能异常和心功能正常患者间无显著差异,均能及时、有效地指导容量治疗。

Objective To explore the strove volume variation （SVV） in estimation of its ability of responding to overload of volume among patients with cardiac dysfunction or normal cardiac function. Methods This prospective study was carried out in January 2015 to May 2016, 27 patients undergoing scheduled off-pump coronary artery bypass grafting （CABG） and 25 patients receiving non-cardiac surgery were enrolled. After induction, 6% hydroxyethyl starch 130/0.4 500 ml were intravenously infused as a volume load within 20 minutes. The values of SVV, SV, APCO, HR, and MAP before infusion and at the end of 500ml HES infusion were recorded. The strove volume （SV） was calculated with FloTrac/Vigileo system. Fluid responsiveness was defined as an increase in stroke volume （SV） ≥10%. Results In patients with decreased myocardial contractility, the value of SVV before infusion was significantly different in comparison with those after infusion （ P 〈0.05）, but the findings of HR, MAP, APCO and SV before and after infusion were compared, and the difference had no statistical significance （ P 〉0.05）. In patients with abnormal cardiac function, there was significant difference between pre-infusion and post-infusion findings of HR, SV and SVV （ P 〈0.05）, MAP and APCO had no significant statistical difference （ P 〉0.05）. The number of cases responding positively to volume load in cardiac surgery group and non-cardiac surgery group were 10 and 20 respectively, while those negatively responding to volume load were 17 and 5 respectively. The baseline SVV and △SVV were both linear correlated with △SV, and the correlation coefficients of Group-A were r 1=0.436, r 2=-0.542, while Group-B were r 1=0.454, r 2=0.497. There was no significant difference between these two regression lines （ P 〉0.05）. Conclusion SVV can predict the volume responsiveness of patients with different cardiac function that with no significant difference, which can timely and effectively guide capacity treatment.