Solus-Biguenet H, Fleyfel M, Tavernier B, Kipnis E, Onimus J, Robin E, Lebuffe G, Decoene C, Pruvot F R, Vallet B
Federation of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire de Lille, Lille, France.
Br J Anaesth. 2006 Dec;97(6):808-16. doi: 10.1093/bja/ael250. Epub 2006 Sep 16.
The aim of this study was to evaluate potential predictors of fluid responsiveness obtained during major hepatic surgery. The predictors studied were invasive monitoring of intravascular pressures (radial and pulmonary artery catheter), including direct measurement of respiratory variation in arterial pulse pressure (PPVart), transoesophageal echocardiography (TOE), and non-invasive estimates of PPVart from the infrared photoplethysmography waveform from the Finapres (PPVfina) and the pulse oximetry waveform (PPVsat).
We conducted a prospective study of 54 fluid challenges (250 ml colloid) given for haemodynamic instability in eight patients undergoing hepatic resection. Fluid responsiveness was defined as an increase in stroke volume index (SVI) >or=10%. The following variables were recorded before each fluid challenge: right atrial pressure (RAP), pulmonary artery occlusion pressure (PAOP), PPVart, PPVfina, PPVsat, and the TOE-derived variables left ventricular end-diastolic area index (LVEDAI), early/late (E/A) diastolic filling wave ratio, deceleration time of the E wave (MDT) of mitral flow and the systolic fraction of the pulmonary venous flow (SF).
Only PPVfina, PPVart (both P<0.001), PPVsat (P=0.02), LVEDAI and MDT (both P=0.04) were different in responder vs non-responder fluid challenges. The areas under the receiver operating characteristic (ROC) curves were 0.81 (PPVfina), 0.79 (PPVart), 0.70 (LVEDAI), 0.68 (PPVsat and MDT), 0.63 (RAP), 0.62 (E/A), 0.55 (PAOP) and 0.42 (SF). The areas under the ROC curves for RAP, E/A, PAOP and SF were significantly less than that for PPVfina (P<0.05 in each case). Only PPVart (r=0.59, P=0.0001) and PPVfina (r=0.56, P=0.0001) correlated with the fluid challenge-induced changes in SVI.
PPVart and PPVfina predict fluid responsiveness during major hepatic surgery. This suggests that intraoperative monitoring of fluid responsiveness may be implemented simply and non-invasively.
本研究旨在评估在肝脏大手术期间获得的液体反应性的潜在预测指标。所研究的预测指标包括血管内压力的有创监测（桡动脉和肺动脉导管），其中包括直接测量动脉脉压的呼吸变异度（PPVart）、经食管超声心动图（TOE），以及通过Finapres的红外光电容积脉搏波描记法波形（PPVfina）和脉搏血氧饱和度波形（PPVsat）对PPVart进行的无创估计。
我们对8例接受肝切除术的患者因血流动力学不稳定给予的54次液体冲击（250 ml胶体）进行了一项前瞻性研究。液体反应性定义为每搏量指数（SVI）增加≥10%。在每次液体冲击前记录以下变量：右心房压力（RAP）、肺动脉闭塞压（PAOP）、PPVart、PPVfina、PPVsat，以及TOE衍生变量左心室舒张末期面积指数（LVEDAI）、舒张期充盈波早/晚（E/A）比值、二尖瓣血流E波减速时间（MDT）和肺静脉血流收缩期分数（SF）。
在有反应与无反应的液体冲击中，只有PPVfina、PPVart（均P<0.001）、PPVsat（P=0.02）、LVEDAI和MDT（均P=0.04）存在差异。受试者工作特征（ROC）曲线下面积分别为0.81（PPVfina）、0.79（PPVart）、0.70（LVEDAI）、0.68（PPVsat和MDT）、0.63（RAP）、0.62（E/A）、0.55（PAOP）和0.42（SF）。RAP、E/A、PAOP和SF的ROC曲线下面积显著小于PPVfina的（各P<0.05）。只有PPVart（r=0.59，P=0.0001）和PPVfina（r=
