颈内静脉呼吸变异度监测胃癌根治术患者容量反应性的准确性

Accuracy of respiratory variations of internal jugular vein in monitoring fluid responsiveness in patients undergoing radical gastrectomy for gastric cancer

目的评价颈内静脉呼吸变异度监测胃癌根治术患者容量反应性的准确性。方法择期行胃癌根治术的患者50例,年龄40~64岁,性别不限,ASA分级Ⅰ或Ⅱ级。于麻醉诱导前,待患者循环功能稳定后记录HR、CVP、心脏指数(CI)、每搏量指数(SVI)、每搏量变异度(SVV)和颈内静脉呼吸变异度,于气管插管后10min时再次记录,并快速输注6%羟乙基淀粉130/0.4注射液7ml/kg,输注时间15min。容量负荷试验后5min内记录上述指标。以容量负荷试验后SVI增加的百分比(△SVI)将患者分为2组:△SVI≥15%为容量反应阳性组,△SVI<15%为容量反应阴性组。结果颈内静脉呼吸变异度监测容量反应性的ROC曲线下面积及其95%可信区间为0.852(0.744~0.961),以颈内静脉呼吸变异度24.6%为临界值监测容量反应性的敏感度和特异度分别为67.6%和92.3%。结论颈内静脉呼吸变异度可作为监测胃癌根治术患者容量反应性的有效指标。

Objective To evaluate the accuracy of respiratory variations of internal jugular vein(IJV)in monitoring fluid responsiveness in patients undergoing radical gastrectomy for gastric cancer.Methods Fifty American Society of Anesthesiologists physical status Ⅰor Ⅱ patients of both sexes,aged 40-64 yr,scheduled for elective radical gastrectomy for gastric cancer,were enrolled in this study.Before induction of anesthesia,the hemodynamic parameters such as heart rate,central venous pressure,cardiac index,stroke volume index(SVI),stroke volume variation and respiratory variation of IJV were recorded after haemodynamics was stable and were recorded again at 10 min after endotracheal intubation,and a loading dose of 6% 130/0.4 hydroxyethyl starch 7 ml/kg was infused over 15 min.The parameters mentioned above were recorded within 5 min after loading dose.Patients were divided into 2 groups according to the percentage of increase in SVI(△SVI)after volume expansion:△SVI≥15% was considered to be a positive response(responder group)and △SVI<15% was considered to be a negative response after volume expansion(non-responder group).Results The area under the receiver operating characteristic curve of respiratory variations of IJV in monitoring fluid responsiveness and 95% confidence interval were 0.852(0.744-0.961).Respiratory variation of IJV 24.6% was considered as the cut-off value and used to monitor fluid responsiveness,and the sensitivity and specificity were 67.6% and 92.3%,respectively.Conclusion Respiratory variation of IJV can be considered as an effective index in monitoring fluid responsiveness in the patients undergoing radical gastrectomy for gastric cancer.