Yu Yi-hua, Dai Hai-wen, Yan Mo-lei, Gong Shi-jin, Cai Guo-long, Zhang Zhao-cai, Chen Jin, Yan Jing
Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, Zhejiang, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009 Aug;21(8):463-5.
To evaluate stroke volume variation (SVV) as a predictor of fluid responsiveness in mechanically ventilated (MV) elderly patients with severe sepsis.
A prospective observation of 31 fluid challenges during fluid resuscitation for treatment of hemodynamic instability in 17 elderly MV patients with severe sepsis was conducted. SVV was measured by pulse indicator continuous cardiac output (PiCCO) system. Fluid responsiveness was defined as the changes in cardiac index (CI) increase after fluid loading (DeltaCI) > or =10%. The changes in hemodynamic parameters and lung water index were observed at the onset of and after fluid therapy. The correlation between DeltaCI and SVV or central venous pressure (CVP) were analyzed.
SVV was decreased significantly after fluid loading [(6.6+/-2.1)% vs.(12.1+/-3.7)%, P<0.01], whereas CVP increased significantly [(12.5+/-3.6) mm Hg vs. (8.9+/-4.1) mm Hg, 1 mm Hg=0.133 kPa, P<0.01]. DeltaCI in response to fluid loading were positively correlated to initial values of SVV (r=0.447, P=0.012), but there was no relationship between CVP and DeltaCI (r=-0.082, P=0.674). The areas under the receiver operating characteristic curve (ROC curve) for SVV was 0.672 [95% confidence interval (95%CI) 0.463-0.885] and CVP was 0.336 (95%CI 0.133-0.539), respectively. A SVV value of 11.5% had the sensitivity of 71% and specificity of 67% for prediction of fluid responsiveness.
Functional hemodynamic parameter SVV can predict fluid responsiveness in elderly MV patients with severe sepsis during fluid resuscitation, it may serve as a useful index for guiding fluid therapy in elderly patients with severe sepsis.
评估每搏量变异度（SVV）作为机械通气（MV）老年重症脓毒症患者液体反应性预测指标的价值。
对17例接受机械通气的老年重症脓毒症患者在液体复苏治疗血流动力学不稳定期间进行的31次液体负荷试验进行前瞻性观察。采用脉搏指示连续心输出量（PiCCO）系统测量SVV。液体反应性定义为液体负荷后心脏指数（CI）增加量（ΔCI）≥10%。观察液体治疗开始时及治疗后的血流动力学参数和肺水指数变化。分析ΔCI与SVV或中心静脉压（CVP）之间的相关性。
液体负荷后SVV显著降低[（6.6±2.1）%对（12.1±3.7）%，P<0.01]，而CVP显著升高[（12.5±3.6）mmHg对（8.9±4.1）mmHg，1mmHg = 0.133kPa，P<0.01]。液体负荷后的ΔCI与SVV初始值呈正相关（r = 0.447，P = 0.012），但CVP与ΔCI之间无相关性（r = -0.082，P = 0.674）。SVV的受试者工作特征曲线（ROC曲线）下面积为0.672[95%置信区间（95%CI）0.463 - 0.885]，CVP的ROC曲线下面积为0.336（95%CI 0.133 - 0.539）。SVV值为11.5%时，预测液体反应性的敏感度为71%，特异度为67%。
功能性血流动力学参数SVV可预测老年MV重症脓毒症患者液体复苏期间的液体反应性，可作为指导老年重症脓毒症患者液体治疗的有用指标。
