每搏量变异度在腹腔镜胃癌根治术中诊断阈值的变化

Changes in stroke volume variation to predict fluid responsiveness in elderly patients undergoing laparoscopic⁃assisted radi⁃cal gastrectomy

目的探究气腹合并头高脚低位15°~30°条件下每搏量变异度(stroke volume variation,SVV)预测老年患者液体反应性的准确性及诊断阈值。方法择期全身麻醉下行腹腔镜下胃癌根治术的老年患者80例。于气腹合并体位变动后5 min(T1),静脉输注6%羟乙基淀粉130/0.4氯化钠注射液7 ml/kg,输注时间15~20 min。于T1、容量负荷后5 min(T2)时记录MAP、心率、心排血量(cardiac output,CO)、心指数(cardiac index,CI)、每搏量(stroke volume,SV)、每搏量指数(stroke volume index,SVI)和SVV。容量负荷后,以每搏量指数变化率(△SVI)≥15%为容量负荷试验阳性的标准,△SVI≥15%定义为有反应组(Rs组),△SVI<15%定义为无反应组(NRs组)。绘制SVV判断容量变化的受试者工作特征(receiver operating characteristic curve,ROC)曲线,计算ROC曲线下面积及95%CI。结果与T1时点比较,T2时点两组患者CI和SVI升高,SVV降低,差异有统计学意义(P<0.05);Rs组T2时点CO和SV升高,差异有统计学意义(P<0.05)。两组患者T1时点比较,Rs组SVV高于NRs组,CI、SV、SVI和CO低于NRs组,差异有统计学意义(P<0.05)。患者心率、MAP组间及组内比较,差异均无统计学意义(P>0.05)。ROC曲线分析结果示:SVV区分容量负荷有无反应的阈值为16.5%时,灵敏度为95.9%,特异性为77.8%,曲线下面积(95%CI)为0.912(0.838~0.987)。结论在本实验条件下,SVV仍保持判断容量治疗反应的准确性,但其诊断阈值升高。SVV的诊断阈值为16.5%。

Objective To explore the accuracy and diagnostic threshold of stroke volume variation(SVV)in elderly patients under pneumoperitoneum in the reverse Trendelenburg position(15°~30°)to predict fluid responsiveness.Methods Eighty elderly patients who were scheduled for laparoscopic‑assisted radical gastrectomy under general anesthesia were enrolled.Then,5 min after pneumoperitoneum combined with placement in the reverse Trendelenburg position(T1),6%hydroxyethyl starch(HES)130/0.4 in sodi‑um chloride injection was intravenously infused at 7 ml/kg over 15 to 20 min.The mean arterial pressure(MAP),heart rate,cardiac out‑put(CO),cardiac index(CI),stroke volume(SV),stroke volume index(SVI)and SVV were recorded at T1 and 5 min after volume expan‑sion(T2).After volume expansion,an increase in SVI(ΔSVI)≥15%was defined as the criterion for effective volume expansion.Patients withΔSVI≥15%was defined as a response group(Rs group),while those withΔSVI<15%was defined as a non‑response group(NRs group).The area under a receiver operating characteristic(ROC)curve for SVV was plotted,while the area under the curve for SVV and 95%confidence interval were calculated.Results Compared with those at T1,patients in both groups presented with remarkable in‑creases in CI and SVI as well as decreases in SVV at T2(P<0.05),significantly increased CO and SV were found in group Rs at T2(P<0.05).At T1,the Rs group presented with marked higher SVV but lower CI,SV,SVI,and CO than the NRs group(P<0.05).There were no significant difference in the heart rate and MAP between the two groups(P>0.05).According to ROC curve analysis,when the threshold of SVV to distinguish responders and non‑responders was set as 16.5%,the sensitivity was 95.9%,the specificity was 77.8%,and the area under the curve was 0.912(95%CI 0.838‒0.987).Conclusions Under the current conditions,SVV is still an accurate predictor to determine fluid responsiveness,with a diagnostic threshold of 16.5%,which is relatively high.