颈动脉校正血流时间评估腹腔镜结直肠手术患者容量反应性的有效性

Efficiency of carotid artery corrected blood flow time in the assessment of volume responsiveness in patients undergoing laparoscopic colorectal surgery

目的探讨颈动脉校正血流时间(FTc)在评估腹腔镜结直肠手术患者容量反应性的有效性。方法选择2021年2—5月择期行腹腔镜结直肠手术患者60例,男32例,女28例,年龄45~70岁,BMI 20~24 kg/m^(2),ASAⅠ或Ⅱ级。分别于气管插管后5 min和肠道吻合完成恢复平卧位后进行补液试验,均在15 min内输注6%羟乙基淀粉6 ml/kg。以每搏量指数(SVI)增加≥15%判定为容量反应阳性,第1次补液与第2次补液后容量反应阳性的患者分别为R_(1)组和R_(2)组,容量反应阴性的患者分别为NR_(1)组和NR_(2)组。记录第1次补液前即刻、第1次补液后5 min、CO_(2)气腹前即刻、CO_(2)气腹后5 min、第2次补液前即刻、第2次补液后5 min的SVI、FTc。采用受试者工作特征(ROC)曲线分析FTc评估容量反应性的效能。结果与补液前即刻比较,第1次补液与第2次补液后5 min R_(1)组和R_(2)组FTc均明显延长(P<0.05)。非CO_(2)气腹状态时,FTc曲线下面积为0.755(95%CI 0.522~0.909,P<0.05),FTc的诊断界值为325 ms,敏感性66.67%,特异性77.78%。CO_(2)气腹状态时,FTc曲线下面积为0.773(95%CI 0.605~0.940,P<0.05),FTc的诊断界值为361 ms,敏感性100%,特异性87.69%。结论FTc可作为评估腹腔镜结直肠手术患者容量反应性的指标,且CO_(2)气腹状态时FTc评估容量反应性具有更高的敏感性与特异性。

Objective To explore the efficiency of carotid artery corrected blood flow time(FTc)in evaluating the volume responsiveness of patients undergoing laparoscopic colorectal surgery.Methods Sixty patients undergoing laparoscopic colorectal surgery from February to May 2021,32 males and 28 females,aged 45-70 years,BMI 20-24 kg/m^(2),ASA physical statusⅠorⅡwere enrolled.Rehydration test was performed 5 minutes after tracheal intubation and after intestinal anastomosis was completed,and 6 ml/kg of 6%hydroxyethyl starch was infused within 15 minutes.Positive volume response was determined by a 15%increase in the stroke volume index(SVI).After first and second rehydration tests,the positive group was marked as R_(1) and R_(2),and the negative group was marked as NR_(1) and NR_(2).Immediately before the first rehydration test,5 minutes after the first rehydration test,immediately before CO_(2) pneumoperitoneum,5 minutes after CO_(2) pneumoperitoneum,immediately before the second rehydration test,and 5 minutes after the second rehydration test,SVI and FTc were recorded.Receiver operating characteristic(ROC)curves were used to analyze the power of FTc to assess volume responsiveness.Results After the rehydration tests,the FTc of the R_(1) and the R_(2) were significantly increased(P<0.05).Before CO_(2) pneumoperitoneum,the area under the FTc curves was 0.755(95%CI 0.522-0.909,P<0.05),and cut-off values of FTc was 325 ms,sensitivity 66.67%,specificity 77.78%.After CO_(2) pneumoperitoneum,the area under the FTc curves was 0.773(95%CI 0.605-0.940,P<0.05),and the cut-off values of FTc was 361 ms(sensitivity 100%,specificity 87.69%).Conclusion FTc can be used to evaluate the volume response of patients undergoing laparoscopic colorectal surgery,and FTc has higher sensitivity and specificity in evaluating the volume response in CO_(2) pneumoperitoneum.