Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Liver Transpl. 2011 Jan;17(1):53-9. doi: 10.1002/lt.22186.
We evaluated the value of the stroke volume variation (SVV) calculated with the Vigileo monitor, which recently has been increasingly advocated for fluid management, as a predictor of fluid responsiveness during the anhepatic phase of liver transplantation (LT). We also compared SVV to the central venous pressure (CVP) and pulmonary arterial occlusion pressure (PAOP) in patients. Thirty-three adult recipients scheduled for elective living donor LT were enrolled in this study. Twenty minutes after the start of the anhepatic phase, the CVP, PAOP, approximate inferior vena caval pressure, femoral SVV, and cardiac output values were measured before and 12 minutes after fluid loading. Fluid loading was performed with a 6% hydroxyethyl starch solution (10 mL/kg). The responders were defined as patients whose cardiac index increased ≥ 15% after fluid loading. Receiver operating characteristic (ROC) analysis showed that only femoral SVV (area under the curve = 0.894, P = 0.0001) could be used to predict fluid responsiveness during the anhepatic phase of LT. The area under the ROC curve for femoral SVV was 0.894 (P = 0.0001), and it was significantly larger than those for CVP (area under the curve = 0.576, P = 0.004) and PAOP (area under the curve = 0.670, P = 0.021). Femoral SVV >8% identified the responders with a sensitivity of 89% and a specificity of 80%. Our results suggest that femoral SVV derived with the Vigileo monitor would be useful for fluid management during the anhepatic phase in LT recipients.
我们评估了最近越来越多被推荐用于液体管理的 Vigileo 监测仪计算的每搏量变异（SVV）作为肝移植（LT）无肝期液体反应性的预测指标的价值。我们还比较了 SVV 与中心静脉压（CVP）和肺动脉闭塞压（PAOP）在患者中的差异。本研究纳入了 33 名计划接受择期活体供者 LT 的成年受者。无肝期开始后 20 分钟，测量液体负荷前和负荷后 12 分钟的 CVP、PAOP、近似下腔静脉压、股 SVV 和心输出量值。液体负荷使用 6%羟乙基淀粉溶液（10 mL/kg）。将心指数增加≥15%定义为液体反应性患者。受试者工作特征（ROC）分析显示，只有股 SVV（曲线下面积=0.894，P=0.0001）可用于预测 LT 无肝期的液体反应性。股 SVV 的 ROC 曲线下面积为 0.894（P=0.0001），明显大于 CVP（曲线下面积=0.576，P=0.004）和 PAOP（曲线下面积=0.670，P=0.021）。股 SVV>8%可识别出 89%的敏感性和 80%的特异性的反应者。我们的结果表明，Vigileo 监测仪得出的股 SVV 将有助于 LT 受者无肝期的液体管理。
