在脊柱侧凸手术中，俯卧位时脉压变化和每搏量变化预测液体反应性的能力。

Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery.

机构信息

Université Victor Segalen Bordeaux, Hôpital Pellegrin, CHU Bordeaux, France.

出版信息

Br J Anaesth. 2010 Apr;104(4):407-13. doi: 10.1093/bja/aeq031. Epub 2010 Feb 26.

DOI:10.1093/bja/aeq031

PMID:20190260

Abstract

BACKGROUND

Pulse pressure variation (PPV) and stroke volume variation (SVV) are robust indicators of fluid responsiveness in mechanically ventilated supine patients. The aim of the study was to evaluate the ability of PPV and SVV to predict fluid responsiveness in mechanically ventilated patients in the prone position (PP) during scoliosis surgery.

METHODS

Thirty subjects were studied after the induction of anaesthesia in the supine position [before and after volume expansion (VE) with 500 ml of hetastarch 6%] and in PP (immediately after PP and before and after VE). PPV, SVV, cardiac output (CO), and static compliance of the respiratory system were recorded at each interval. Subjects were defined as responders (Rs) to VE if CO increased > or =15%.

RESULTS

Three subjects were excluded. In the supine position, 16 subjects were Rs. PPV and SVV before VE were correlated with VE-induced changes in CO (r(2)=0.64, P<0.0001 and r(2)=0.56, P<0.0001, respectively). Fluid responsiveness was predicted by PPV >11% (sensitivity=88%, specificity=82%) and by SVV >9% (sensitivity=88%, specificity=91%). PP induced an increase in PPV and SVV (P<0.0001) and a decrease in the static compliance of the respiratory system (P<0.0001). In PP, 17 patients were Rs. PPV and SVV before VE were correlated with VE-induced changes in CO (r(2)=0.59, P<0.0001 and r(2)=0.55, P<0.0005, respectively). Fluid responsiveness was predicted in PP by PPV >15% (sensitivity=100%, specificity=80%) and by SVV >14% (sensitivity=94%, specificity=80%).

CONCLUSIONS

PP induces a significant increase in PPV and SVV but does not alter their abilities to predict fluid responsiveness.

摘要

背景

脉压变异（PPV）和每搏变异（SVV）是机械通气仰卧位患者液体反应性的可靠指标。本研究旨在评估 PPV 和 SVV 在脊柱侧弯手术中机械通气俯卧位（PP）患者预测液体反应性的能力。

方法

在诱导麻醉后，30 名患者被分为仰卧位组[容量扩充前后（VE，500ml 贺斯 6%）]和俯卧位组（PP），记录 PPV、SVV、心输出量（CO）和呼吸静态顺应性。如果 CO 增加>或=15%，则将患者定义为 VE 有反应者（Rs）。

结果

排除 3 名患者后，在仰卧位组 16 名患者为 Rs。VE 前的 PPV 和 SVV 与 VE 诱导的 CO 变化相关（r(2)=0.64，P<0.0001 和 r(2)=0.56，P<0.0001）。PPV>11%（灵敏度=88%，特异性=82%）和 SVV>9%（灵敏度=88%，特异性=91%）可以预测液体反应性。PP 引起 PPV 和 SVV 增加（P<0.0001）和呼吸静态顺应性降低（P<0.0001）。在 PP 组，17 名患者为 Rs。VE 前的 PPV 和 SVV 与 VE 诱导的 CO 变化相关（r(2)=0.59，P<0.0001 和 r(2)=0.55，P<0.0005）。PPV>15%（灵敏度=100%，特异性=80%）和 SVV>14%（灵敏度=94%，特异性=80%）可以预测 PP 中的液体反应性。