颈总动脉超声血流指标评估全麻诱导期容量变化的临床观察

Common Carotid Artery Blood Flow Ultrasonography in Monitoring Volume Status during Induction of General Anesthesia

目的:观察颈总动脉超声血流指标峰流速变异(△Peak-CCA)及校正射血时间(FTc-CCA)在全麻诱导期的液体反应性,探讨指标在围术期容量监测中的应用价值。方法:纳入拟气管内插管全麻下行择期手术的患者116例,年龄18~65岁,ASA分级Ⅰ~Ⅱ级,体重指数15~30kg/m^2,随机分为对照组(40例)、晶体组(38例)及胶体组(38例),患者入室后给予乳酸林格氏液10mL/kg·h行背景输注,常规麻醉监测及诱导插管;晶体组、胶体组于麻醉气管插管后10min分别输注乳酸林格氏液或羟乙基淀粉130/0.4氯化钠注射液(万汶),负荷量为6mL/kg,持续时间为15min。三组病例于液体负荷试验前、液体负荷试验后5min分别通过床旁超声测量和计算颈总动脉在一个呼吸周期内的△Peak-CCA、FTc-CCA,同时观察记录患者的心率(HR)、平均血压(MBP)。结果:实施液体负荷试验前,三组患者△Peak-CCA和FTc-CCA组间差异无统计学意义(P>0.05)。实施液体负荷试验后,晶体组和胶体组复测△Peak-CCA较前减小、FTc-CCA较前增加,差异有统计学意义(P<0.05),且分别与对照组相比,差异均有统计学意义(P<0.05),但晶体组与胶体组组间比较差异无统计学意义(P>0.05)。三组患者HR、MBP在液体负荷试验前后两个时点的组内及组间比较差异均无统计学意义(P>0.05)。结论:超声测量△Peak-CCA、FTc-CCA能准确反映全麻诱导期患者实施液体负荷试验前后的容量状态变化,可作为可靠、无创的围术期容量监测方法。

Objective:To investigate the volume responsiveness of two ultrasounography measurements of common carotid artery(CCA)blood flow,peak velocity variation(△Peak-CCA)and corrected flow time(FTc-CCA),after a fluid challenge during induction of general anesthesia,and to explore their application value of intraoperative use.Methods:116 patients(aged 18~65 years,ASA classification Ⅰ~Ⅱ,BMI of 15~30 kg/m^2)undergoing elective surgery with general anesthesia were enrolled,and randomly divided into control group(n=40),crystal group(n=38)and colloidal group(n=38).Before anesthesia,all the patients were treated with Ringer’s solution given in a dose of 10 mL/kg·h.10 min after induction,6 mL/kg Ringer’s solution was given within 15 min in crystal group,while colloidal group received 6% HES in a dose of 6 mL/kg within 15 min.Ultrasound assessments of peak velocity variation(△Peak-CCA)and corrected flow time(FTc-CCA)over a single respiratory cycle were measured before and 5 min after the fluid challenge,heart rate(HR)and mean blood pressure(MBP)of all patients were observed and recorded as well.Results:Before a single fluid challenge was performed,there was no significant difference in △Peak-CCA and FTc-CCA between the three groups(P>0.05).At 5 min after the fluid challenge,the crystal group and colloidal group had lower △PeakCCA and higher FTc-CCA than before,and there was statistical significance in the difference(P<0.05).Compared to control group at 5 min after the fluid challenge,the △Peak-CCA in crystal group and colloidal group were also significant lower(P<0.05),while the FTc-CCA in crystal group and colloidal group were significant higher(P<0.05),but neither of them were significantly different between crystal group and colloidal group(P>0.05).There was no significant difference in HR and MBP before and after the fluid challenge between and within groups(P>0.05).Conclusions:Ultrasounography assessments of CCA,△Peak-CCA and FTc-CCA can predict intravascular volume changes after fluid challenge and may be recommended as reliable noninvasive methods to monitor fluid status in the perioperative period.