颈动脉校正血流时间与颈动脉峰值流速变异度评估胃肠道肿瘤患者麻醉诱导前容量反应性

Carotid FTc andΔVpeak-CA Assessing Fluid Responsiveness before Anesthesia Induction in Patients with Gastrointestinal Cancer

目的:评估颈动脉校正血流时间(corrected flow time,FTc)和颈动脉峰值流速变异度(respirophasic variation in carotid artery blood flow peak velocity,ΔVpeak-CA)预测胃肠道肿瘤患者麻醉诱导前容量反应性的准确性。方法:选择2019年7月至2021年11月择期全身麻醉下手术的胃肠道肿瘤患者61例,男性24例,女性37例,年龄18~65岁,BMI:18~30 kg/m^(2),ASA分级Ⅰ或Ⅱ级。所有患者麻醉诱导前,行容量负荷试验(静脉输注复方氯化钠液10 mL/kg,于25~30 min内匀速输完)。以每搏输出量(stroke volume,SV)的升高幅度(ΔSV)≥10%作为容量反应性的判断标准,分为无容量反应性组(N组,n=21)和有容量反应性组(R组,n=40)。记录患者容量负荷试验前5 min和试验后5 min的心率、平均动脉压、颈动脉收缩期时间、心动周期、射血分数、SV、颈动脉峰值流速最大值和最小值,并绘制FTc和ΔVpeak-CA预测胃肠道肿瘤患者麻醉诱导前容量反应性的ROC曲线。结果:颈动脉FTc与容量负荷试验后ΔSV呈明显负相关(r=-0.67,P<0.001),预测容量反应性的AUC为0.774,敏感性和特异性分别为80%和71.4%。颈动脉ΔVpeak-CA与容量负荷试验后ΔSV呈明显正相关(r=0.425,P<0.001),预测容量反应性的AUC为0.768,敏感性和特异性分别为77.5%和61.9%。结论:颈动脉FTc和ΔVpeak-CA对胃肠道肿瘤手术患者麻醉诱导前容量反应性评估均有一定预测价值。

Objective:To evaluate the accuracy of carotid corrected flow time(FTc)and respirophasic variation in carotid artery blood flow peak velocity(∆Vpeak-CA)in predicting gastrointestinal cancer patients’fluid responsiveness before anesthesia induc-tion.Methods:61 patients,24 males and 37 females,aged 18~65,with BMI of 18~30 kg/m^(2)and ASA physical status I to II,scheduled for elective gastrointestinal cancer surgery with general anesthesia from July 2019 to November 2021,were enrolled in the study.Volume load test(intravenous infusion of compound sodium chloride solution 10 mL/kg,which was completed at a uniform speed within 25~30 min)was performed in all patients before anesthesia induction.Fluid responsiveness was defined as the 10%or more increase in stroke volume(∆SV)after the fluid challenge,which serves as a benchmark for assigning 21 patients to the non-responder group and 40 patients to the responder group.Heart rate,mean arterial pressure,carotid systolic flow time,cycle time,ejection fraction,stroke volume,maximum carotid artery blood flow peak velocity and minimum carotid artery blood flow peak velocity were recorded 5 min before and 5 min after volume load test.The receiver operating characteristic(ROC)curve of carotid FTc and∆Vpeak-CA predicting fluid responsiveness before anesthesia induction in patients with gastrointestinal cancer was plotted.Results:Carotid FTc was negatively correlated to∆SV(r=-0.67,P<0.001).The area under the curve of carotid FTc predicting fluid responsiveness was 0.774,with the sensitivity and specificity of 80%and 71.4%.∆Vpeak-CA was positive correlated to∆SV(r=0.425,P<0.001).The area under the curve of∆Vpeak-CA predicting fluid responsiveness was 0.768,with the sensitivity and specificity of 77.5%and 61.9%.Conclusion:Both carotid FTc and∆Vpeak-CA are valuable in predicting fluid responsiveness before anesthesia induction in patients undergoing gastrointestinal surgery.