每搏量变异度评估老年冠心病单肺通气患者容量的可行性

The feasibility study of stroke volume variability for evaluating ventilation-volume of one lung ventilation in patients with elderly coronary heart disease

目的通过观察单肺通气(OLV)期间Flo Trac/Vigileo心排血量监测系统的监测指标每搏量变异度(SVV)与容量变化的关系,评价SVV反映老年冠心病(CHD)患者OLV时容量变化的可行性。方法40例行择期胸腔镜手术的CHD患者,年龄60~82岁,美国麻醉医师学会分级Ⅱ或Ⅲ级。双腔管气管插管OLV后分别以(T0)2 ml/kg、(T1)4 ml/kg、(T2)6 ml/kg、(T3)8 ml/kg、(T4)10 ml/kg为一个输液阶段,静脉输注6%羟乙基淀粉130/0.4氯化钠注射液(HES 130/0.4),剂量每递增一个阶段暂停输液,数据稳定后记录各监测数值:平均动脉压(MAP)、中心静脉压(CVP)、SVV,剂量达到10 ml/kg终止,观察患者不同时点MAP、心率、CVP、心排量、SVV变化的情况。结果患者在不同时间点MAP比较差异均无统计学意义(F=2.089,P=0.130),而SVV、CVP、心率和心排量不同时间点比较差异有统计学意义(F=23.380、4.726、15.205、14.990,P=0.000、0.010、0.000、0.000);经组间两两比较结果显示,SVV在T0、T1、T2、T3、T4相邻不同时间点逐渐降低(P=0.000、0.000、0.042、0.033);而CVP在两两相邻不同时间点比较差异无统计学意义(P=0.093、0.161、0.261、0.051);T0和T1时间点比较、T1和T2时间点比较心率均下降(P=0.015、0.028),其他时间点比较差异无统计学意义(P=0.149、0.335);心排量值除T3和T4时间点比较心排量增加外(P=0.005),T0和T1时间点比较、T1和T2时间点比较、T2和T3时间点比较,心排量差异均无统计学意义(P=0.547、0.441、0.400)。相关性分析结果显示,MAP与HES 130/0.4输注量呈正相关(r=0.921、P=0.021),SVV、心率与HES 130/0.4输注量呈负相关(r=-0.988、-0.984、P=0.001、0.002),CVP、心排量与HES 130/0.4输注量无相关性(r=0.872、0.871,P=0.054、0.055)。结论SVV可有效评估老年CHD患者OLV的容量反应性。

Objective To observe the relationship between Flo Trac/Vigileo monitor-assessed stroke volume variability(SVV) and changes in ventilation volume during one lung ventilation(OLV), and to evaluate the feasibility of SVV reflecting changes in lung ventilation volume during OLV in patients with elderly coronary heart disease. Methods A total of 40 patients with ASA grade Ⅱ or Ⅲ, aged 60-82 years, undergoing elective thoracoscopic surgery were enrolled in this study.A double-lumen endobronchial tube was inserted, and 6% hydroxyethyl starch(HES 130/0.4)was infused intravenously for five dosage-infusion-stage of(T0)2 ml/kg,(T1)4 ml/kg,(T2)6 ml/kg,(T3)8 ml/kg,(T4)10 ml/kg.And the infusion was suspended until starting next infusion stage.After the data reached the stability, the mean arterial pressure(MAP), heart rate(HR), central venous pressure(CVP), cardiac output(CO)and SVV were recorded.The test was stopped after stage of(T4)10 ml/kg.Then, we observed and analyzed the changes of MAP, HR, CVP, CO and SVV at different time points. Results The statistically significant difference was not found in MAP(F=2.089, P=0.130), but was definitely found in SVV, HR, CO and CVP between five different time points(F=23.380, 15.205, 14.990, 4.726, P=0.000, 0.060, 0.000 and 0.001, respectively). SVV(%)was 12.6±1.8 at T0, 10.7±1.7 at T1, 9.7±1.3 at T2, 8.6±1.2 at T3, 7.8±1.2 at T4, with a gradually decreased trend(P=0.000, 0.000, 0.042, 0.033, between any two adjacent time points, respectively). While CVP had no significant difference between any two adjacent time points(P=0.093, 0.161, 0.261 and 0.051, respectively). HR was lower in T1 vs.in T0, and in T2 vs.in T1(P=0.015 and 0.028, respectively). There was no significant difference in HR between the other time points(P=0.149 and 0.335, respectively). The CO was higher at T4 than at T3(P=0.005), and there was no significant difference among any other time points(T0 vs.T1, T1 vs.T2, T2 vs.T3, P=0.547, 0.441 and 0.400, respectively). In Spearman correlation analysis, the amount of HES infusion was positively correlated with MAP(r=0.921, P=0.021), negatively correlated with SVV and HR(r=-0.988,-0.984, P=0.001, 0.002, respectively), and not correlated with CVP and CO(r=0.872 and 0.871, P=0.054 and 0.055, respectively). Conclusions SVV can effectively evaluate the volume responsiveness in elderly CHD patients with OLV.