每搏量变异度监测肝叶切除患者血容量变化的准确性评价

Accuracy evaluation of blood volume change in patients with hepatectomy after stroke volume variability

目的探讨每搏变异度(SVV)监测肝叶切除手术患者血容量变化的准确性。方法选择2015年5月~2016年5月在我院行肝叶切除术的患者60例,所有患者在麻醉后行气管插管,15min后以0.4m L/(kg·min)的速度静脉输注6%羟乙基淀粉(8m L/kg),麻醉前(T0)、麻醉后30min(T1)、肝叶切除结束即刻(T2)、手术结束即刻(T3)4个时间点,常规监测患者的中心静脉压、心脏指数(CI)、心率和SVV等血流动力学指标,计算SVV和CI的变化率(ΔSVV和ΔCI),并以ΔCI≥15%为扩容有效标准,绘制SVV监测血容量变化的受试者工作特性曲线(ROC),计算曲线下面积(AUC)及灵敏度、特异度。结果患者在T2时刻的MAP、CVP及CI明显高于T0、T1时刻(P<0.05),明显低于T3时刻(P<0.05);HR在T1、T2、T3时刻无明显变化(P>0.05),但均高于T0时刻(P<0.05);SVV在T2时刻明显低于T0、T1、T3时刻(P<0.05);以ΔCI≥15%为扩容有效标准,SVV对CI反应的AUC值为0.879(95%CI 0.824~0.987),诊断阈值为12.5%,灵敏度为84.76%,特异度为81.29%。结论 SVV能够准确监测肝叶切除患者手术中血容量变化情况,对于术中容量治疗具有很好的应用价值。

Objective To investigate the accuracy of stroke variability(SVV)in monitoring blood volume changes in patients undergoing hepatectomy.Methods A total of sixty patients with lobectomy were enrolled in our hospital from May 2015 to May 2016.All patients were intubated after anesthesia,After 15 minutes,6%hydroxyethyl starch(8 ml/kg)was intravenously infused at a rate of 0.4 mL/(kg·min).Before the anesthesia(T0),30 minutes after anesthesia(T1),the end of the hepatectomy(T2),and the end of surgery(T3)4 time points,routine monitoring of patients(ΔSVV andΔCI)of SVV and CI were calculated by using hemodynamic parameters such as central venous pressure,cardiac index(CI),heart rate and SVV,and the blood volume was measured with the threshold ofΔCI≥15%(ROC),the area under the curve(AUC),and the sensitivity and specificity.Results MAP,CVP and CI of T2 were significantly higher than T0 and T1(P<0.05),which was significantly lower than T3(P<0.05).There was no significantly change in HR of T1,T2 and T3(P>0.05),but higher than T0(P<0.05).SVV of T2 was significantly lower than that of T0,T1 and T3(P<0.05).UsingΔCI≥15%as a effective standard,the AUC value of SVV reaction to CI was 0.879(95%CI 0.824-0.987),the diagnostic threshold was 12.5%,the sensitivity was 84.76%,and the specificity was 81.29%.Conclusion SVV can accurately monitor the changes of blood volume in patients undergoing lobectomy,which is great value for intraoperative volume therapy.