| 摘要: |
| 目的探讨肺保护策略对择期行胸外科手术患者每搏量变异度(SVV)的影响。方法选择20例择期行开胸手术的患者, ASA分级Ⅰ~Ⅱ级,均无术前用药。研究患者清醒平卧位自主呼吸(T1)、清醒侧卧位自主呼吸(T2)、单纯全麻平卧位双肺通气(T3)、单纯全麻平卧位肺保护策略下单肺通气(T4)、单纯全麻侧卧位双肺通气(T5)、单纯全麻侧卧位肺保护策略下单肺通气(T6)、联合麻醉肺保护策略下单肺通气切皮时(T7)以及联合麻醉肺保护策略下单肺通气切开胸膜时(T8)的心率(HR)、平均动脉压(MAP)、SVV、心脏指数(CI) 4个血流动力学指标的变化,以及SVV 变化与HR、MAP、CI 的相关性。4个指标数据组内采用单因素方差分析,根据方差齐性检验结果决定进一步统计学检验方案,4个数据组间采用Pearson相关分析。结果单因素方差分析结果显示,T1~T8时间点SVV、HR变化差异无统计学意义(P>0.05), MAP、CI 的变化差异有统计学意义(P<0.05)；方差齐性LSD多重比较结果显示,SVV在T2时间点与T5时间点之间,CI 在T1时间点与T3~T8时间点之间,CI 在T2时间点与T4时间点、T6~T8时间点之间,MAP 在T1时间点与T3～T4时间点、T6～T8时间点之间,MAP 在T2时间点与T3～T4时间点、T6～T8时间点之间,MAP 在T4时间点与T5时间点之间差异有统计学意义(P<0.05)。相关分析结果显示SVV与CI呈负相关(r=-0.267, P=0.018)。结论术前无容量不足的患者体位改变(从仰卧位到侧卧位)对SVV和HR无显著影响；肺保护策略下单肺通气对SVV、HR、MAP和CI均无显著影响；麻醉因素可引起MAP和CI明显下降,且麻醉状态下被动翻身动作可引起MAP和CI升高,SVV变化与CI呈负相关,但相关性较弱。 |
| 关键词: 体位 每搏量变异度 肺保护策略 单肺通气 |
| DOI：10.3724/SP.J.1008.2012.001329 |
| 投稿时间：2012-09-15修订日期：2012-11-23 |
| 基金项目: |
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| Effect of lung protection strategy on stroke volume variation in patients undergoing open-chest operation |
| LU Zhu-feng1,2 ,GE Sheng-jin2,XUE Zhang-gang2,DENG Xiao-ming1* |
(1. Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
2. Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
*Corresponding author.) |
| Abstract: |
| ObjectiveTo investigate the effect of lung-protective ventilation mode on stroke volume variation (SVV) in patients receiving selected thoracotomy. MethodsTwenty patients of the American Society of Anesthesiology (ASA) class Ⅰ or class Ⅱ were selected for this study, with no drugs administrated before operation. In addition to standard hemodynamic monitoring, SVV and cardiac index (CI) were recorded at the following eight time points: spontaneous breathing when awake and at supine position (T1), spontaneous breathing when awake and at lateral position (T2), general anesthesia with two-lung ventilation and at supine position (T3), general anesthesia with one-lung ventilation under lung-protective strategy and at supine position (T4), general anesthesia with two-lung ventilation and at lateral position (T5), general anesthesia with one-lung ventilation under lung-protective strategy and at lateral position (T6), combined anesthesia with one-lung ventilation under lung-protective strategy when skin incision (T7), and combined anesthesia with one-lung ventilation under lung-protective strategy when pleural dissection (T8). The changes of heart rate (HR), mean arterial pressure (MAP), SVV, and CI were observed at the above eight time points; and the relation of SVV with HR, MAP and CI was discussed. Homogenity test of variances was used to analyze the data of the four indices; the use of further statistical scheme was judged by the result of homoscedasticity. A Pearson correlation analysis was used for SVV with HR, MAP, and CI. ResultsHomogenity of variance test showed that the changes of SVV and HR at T1 -T8 had no significant difference (P>0.05), while the changes of MAP and CI had significant difference (P<0.05). LSD multiple comparison indicated significant differences for the followings (P<0.05): SVV between T2 and T5, CI among T1 and T3-8, CI among T2 and T4,6,7,8, MAP among T1 and T3,4,6,7,8, MAP among T2 and T3,4,6,7,8, and MAP between T4 and T5. We also found that SVV had negative correlation with CI (r=-0.267, P=0.018). ConclusionThe change of body position (from supine to lateral position) in patients without hypovolemia before operation has no significant impact on SVV and HR; one-lung ventilation under lung-protective strategy has no noticeable effects on SVV, HR, MAP or CI. Anesthetic factor can cause the drop of MAP and CI, and the action of passive position change under anesthesia can result in the rise of MAP and CI. Alteration of SVV has negative correlation with CI, but the correlation is weak. |
| Key words: posture stroke volume variation lung-protective strategy one-lung ventilation |
