| 摘要: |
| 目的 评价非心脏大手术中心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、肺动脉楔压(PAWP)和每搏量变异度(SVV)对容量不足导致每搏指数(SVI)低于正常的判断能力。方法 择期拟行骶骨肿瘤或后腹膜巨大肿瘤手术的患者12例,麻醉诱导气管插管后行桡动脉穿刺置管和颈内静脉置漂浮导管,放置完毕后即刻测定HR、MAP、CVP、PAWP、SVV、SVI,每隔30 min测定1次。如在预定测量时点之前的5 min内为维持血压使用了去氧肾上腺素,则测量时间推迟到给药后5 min时进行；如该患者需要持续泵注血管活性药物或强心药物维持灌注压则本例采集数据停止,否则至手术末期降低七氟烷浓度时止。作HR、MAP、CVP、PAWP、SVV各指标相对SVI<25 ml/m2的ROC曲线,计算曲线下面积。结果 SVV判断SVI<25 ml/m2的AUC为0.837；HR、MAP、CVP和PAWP判断SVI<25 ml/m2的AUC分别为0.615、0.647、0.623和0.658。SVV的ROC曲线上约登指数最大值出现在界值为9.5%时,此时灵敏度为82.4%,特异度为74.6%。结论 SVV对容量不足导致SVI低于正常的判断能力中等,HR、MAP、CVP及PAWP的判断能力较低。 |
| 关键词: 血容量不足 每搏指数 每搏量变异度 血流动力学 |
| DOI：10.3724/SP.J.1008.2010.00 |
| 投稿时间：2010-04-05修订日期：2010-09-01 |
| 基金项目: |
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| Efficacy of different hemodynamic parameters in assessment of low stroke volume index caused by volume deficiency in major non-cardiac surgeries |
| BAO Rui, FAN Xiao-hua, LI Bo, MAO Jia,DENG Xiao-ming |
| (BAO Rui, FAN Xiao-hua, DENG Xiao-ming*, LI Bo, MAO Jia;Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China) |
| Abstract: |
| Objective To investigate the efficacies of heart rate (HR), mean artery pressure (MAP),central venous pressure (CVP), pulmonary artery wedge pressure (PAWP) and stroke volume variation (SVV) in assessing low stroke volume index (SVI) caused by volume deficiency in major non-cardiac surgeries. Methods Twelve patients undergoing sacral or retroperitoneal tumor resection were enrolled in this study. After induction and onset of mechanical ventilation, radial artery was cannulated and connected to FloTrac for BP and SVV monitoring. Swan-Ganz catheter was placed via internal jugular vein into the pulmonary artery for CVP,PAWP, and SVI monitoring. HR, MAP, CVP, PAWP, SVV, and SVI were recorded every 30 min. If phenylephrine was injected within 5 min before the time point for data-record, the record should be postponed to 5 min after the injection. If vasoconstrictor or cardiotonic was injected intravenously and continuously to keep the normal blood pressure, the data-record in this patient should be stopped then, otherwise it should be stopped when the concentration of sevoflurane was turned lower at the end stage of the operation. The receiver operating characteristic (ROC) curves of HR, MAP, CVP, PAWP, and SVV were made according to a low stroke volume which was less than 25 ml/m2 and AUC(area under curve) were counted. Results The AUC of SVV for assessment of a low SVI was 0.837, while AUC of HR, MAP, CVP and PAWP were 0.615, 0.647, 0.623, and 0.658, respectively. The highest Youden’s index was at the point when SVV was 9.5% in its ROC curve, with a sensitivity of 82.4% and specificity of 74.6%. Conclusion SVV is a middle-level effective variable to assess the abnormally low SVI caused by volume deficiency, while HR, MAP, CVP and PAWP have a low efficacy for the same assessment. |
| Key words: hypovolemia stroke volume index stroke volume variation hemodynemics |
