脉压变异度预测容量反应的临床研究

Prediction of fluid responsiveness by pulse pressure variation in patient

目的:评估脉压变异度(PPV)在全麻手术中预测容量反应的准确性。方法:择期行胃肠手术的患者45例,常规麻醉诱导后补液治疗,以补液后心指数(CI)增加≥15%为标准,将患者分为有反应组和无反应组。将两组患者补液前(T1)、补液后(T2)后的心率(HR)、收缩压(SBP)、舒张压(DBP)、重脉压(Pdic)、体循环阻力指数(SVRI)、每搏量指数(SVI)、心指数(CI)、脉压变异度(PPV)和收缩/舒张最大压力梯度(dp/dt)进行统计学分析。结果:补液治疗后有反应者25例,无反应者20例。有反应组容量负荷试验后SBP、DBP、SVI、CI、dp/dt明显升高,HR、PPV明显下降(均P<0.05);PPV预测容量反应性的ROC曲线下面积为0.86(95%CI:0.755~0.965,P<0.01),以PPV≥12.96%为诊断阈值,敏感度为84%,特异性为70%。结论:在全麻手术中,PPV可以准确预测容量反应,在维持循环稳定的同时,有效精确地指导术中补液。

Objective: To evaluate whether pulse pressure variation(PPV) could predict fluid responsiveness. Methods: 50 Patients undergoing gastrointestinal surgery were recruited from Capital Medical University Affiliated Beijing friendship hospital between January 2020 and June 2020. After anesthesia, volume loading test was performed with hydroxyethyl starch(HES) for 8 mL/kg. PPV was recorded along with heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DPB), Pdic, systemic vascular resistance index(SVRI), stroke volume index(SVI), cardiac index(CI) and the maximal rate of pressure upstroke(dp/dt). 50 patients were divided into two groups according to CI changes after volume loading test, patients were considered as responders(Group R) to fluid loading when CI increased ≥15%, otherwise non-responders(Group NR). Receiver operating curve(ROC) analysis was established to evaluate the accuracy of PPV to predict fluid responsiveness. Results: Group R consisted of 25 patients and Group NR consisted of 20 patients. After fluid loading, SBP, DBP, SVI, CI, dp/dt in Group R increased significantly(all P<0.05). By ROC analysis, the accuracy to predict fluid responsiveness was 0.86(95% CI: 0.755-0.965,P<0.01). The cut off value for PPV was 13% with a sensitivity of 84% and a specificity of 70%. Conclusions: Fluid management plays an important role to maintain hemodynamic stability in patients. PPV are predictive of fluid responsiveness and useful for guiding fluid management.