脉搏灌注变异指数在不同容量状态下预测容量反应的效果

Effect of fluid responsiveness of pleth variability index predicting volume changes during different volume conditions

目的探讨急性等容血液稀释(ANH)和急性高容血液稀释(AHH)期间脉搏灌注变异指数(PVI)预测患者容量变化的有效性。方法选取择期手术患者30例,男22例,女8例,年龄18~65岁,BMI<30 kg/m 2,ASAⅠ或Ⅱ级。按照血液稀释的方法不同分成两组:等容血液稀释组(ANH组,n=15)和高容血液稀释组(AHH组,n=15)。ANH组从5个时点采集数据:基础值(全麻诱导插管后)、第1次抽出5%预估血容量(EBV)、第2次抽出5%EBV、第1次输注同等容量的6%羟乙基淀粉溶液(HES)、第2次输注5%EBV的HES;AHH组从3个时点采集数据:基础值、第1次输注5%EBV的HES、第2次输注5%EBV的HES。记录以上时点的PVI,对PVI和不同容量状态的反应进行相关性分析。结果ANH组的基础血容量与PVI相关性较低(r=0.259,P=0.352);在ANH放血时,放血5%EBV与PVI(r=0.530,P<0.05)及放血10%EBV与PVI(r=0.547,P<0.05)相关性中等;在ANH回输时,回输5%EBV与PVI(r=-0.164,P=0.560)及回输10%EBV与PVI(r=-0.160,P=0.569)相关性较低。AHH组的基础血容量与PVI相关性较低(r=0.146,P=0.603);在AHH扩张容量时,扩容5%EBV与PVI(r=-0.538,P<0.05)及扩容10%EBV与PVI(r=-0.577,P<0.05)相关性中等。结论不论是低容量还是高容量状态,PVI均能够预测容量反应,但敏感性一般。

Objective To investigate the effectiveness of pulse perfusion variation index(PVI)predicting volume changes of patients during acute normovolemic hemodilution(ANH)condition and acute hypervolemic hemodilution(AHH)condition.Methods Thirty patients undergoing elective surgery,22 males and 8 females,aged 18-65 years,with a BMI<30 kg/m 2,falling into ASA physical statusⅠorⅡcategory,were randomly divided into two groups according to the method of hemodilution:isovolumetric hemodilution group(group ANH,n=15)and high volume hemodilution group(group AHH,n=15).The data of group ANH were collected from 5 time points:baseline value(after induction of general anesthesia),5%estimated blood volume(EBV)for the first time,5%EBV for the second time,equivalent capacity about 6%hydroxyethyl starch solution(HES)for the first infusion,and the second infusion of 5%EBV HES.Data of AHH group were collected from 3 time points:baseline value,first infusion of 5%EBV HES;and infusion of 5%EBV HES for the second time.The PVI at the above time points was recorded,and correlation analysis was performed between PVI and different capacity states.Results The basal blood volume of group ANH was not correlated with PVI(r=0.259,P=0.352).When group ANH were bled,5%loss of blood volume and PVI(r=0.530,P<0.05),10%loss of blood volume and PVI(r=0.547,P<0.05)had a good correlation.When group ANH were replenished capacity,5%blood volume and PVI(r=0.164,P=0.560),meanwhile 10%blood volume and PVI(r=0.160,P=0.569)were not relevant.The basal blood volume of the group AHH was not correlated with PVI(r=0.146,P=0.603).When expansion capacity was expanded in the group AHH,expansion of 5%blood volume and PVI(r=0.538,P<0.05),expansion of 10%blood volume and PVI(r=-0.577,P<0.05)had a good correlation.Conclusion PVI is sensitive to predicting volume response,in both low-volume and high-capacity states.