上腔静脉塌陷指数预测机械通气患者容量反应的可行性

Feasibility of superior vena cava collapsibility predicting fluid responsiveness in mechanically ventilated patients

目的探索上腔静脉塌陷指数(SVC-CI)对机械通气患者容量反应的预测效果。方法选择择期气管插管全麻机械通气下行腹部手术患者36例,男20例,女16例,年龄18~64岁,ASAⅠ或Ⅱ级,NYHAⅠ或Ⅱ级。所有患者在全麻诱导后至手术开始前,快速输注复方乳酸钠10 ml/kg,输注时间10~15 min。记录补液前后MAP、HR、CVP、心脏指数(CI)、每搏量变异度(SVV),利用经食管超声心动图测量上腔静脉(SVC)内径,并计算补液前后CI的变化值(ΔCI)以及SVC-CI。根据ΔCI将患者分为容量反应组(R组,ΔCI≥15%)和非容量反应组(NR组,ΔCI<15%)。采用受试者工作特征(ROC)曲线评估SVC-CI和SVV预测容量反应的效能。结果有20例(56%)患者出现容量反应。R组SVC-CI明显高于NR组(P<0.05)。SVC-CI预测容量反应的ROC曲线下面积为0.816(95%CI 0.673~0.958),敏感性85%,特异性75%。SVV预测容量反应的ROC曲线下面积为0.731(95%CI 0.567~0.895),敏感性55%,特异性88%。结论SVC-CI和SVV均可预测机械通气患者容量反应,而SVC-CI的预测效能优于SVV。

Objective To investigate whether the superior vena cava collapsibility index(SVC-CI)predicts fluid responsiveness in mechanically ventilated patients.Methods Thirty-six patients,20 males and 16 females,aged 18-64 years,ASA physical status Ⅰ or Ⅱ and NYHA class Ⅰ or Ⅱ,who underwent selective operation under general anesthesia were enrolled.All patients received Ringer’s lactate solution 10 ml/kg for 10-15 minutes.The data including MAP,HR,CVP,CI,SVV,SVC were recorded before and after fluid challenge.SVC was measured by transesophageal echocardiography while CI and SVV were recorded using FloTrac/Vigileo technology.Patients were separated into responders(ΔCI≥15%after fluid challenge in group R)and non-responders(ΔCI<15%in group NR).Receiver operating characteristic(ROC)curve analysis was used to assess the accuracy and cut-off of SVC-CI and SVV to predict fluid responsiveness.Results There were 20 responders and 16 non-responders.The baseline SVC-CI was significantly higher in group R than in group NR(P<0.05).The area under the ROC curve of SVC-CI was 0.816(95%CI 0.673-0.958)with a sensitivity of 85%and a specificity of 75%,respectively.The area under the ROC curve of SVV was 0.731(95%CI 0.567-0.895)and the sensitivity of SVV was only 55%,the specificity was 88%.Conclusion The superior vena cava collapsibility(SVC-CI)and SVV can be used to predict fluid responsiveness in mechanically ventilated patients.And SVC-CI was superior in predicting fluid responsiveness compared with SVV.