Lu Wenqing, Dong Jing, Xu Zifeng, Shen Hao, Zheng Jijian
Department of Anesthesiology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China (mainland).
Med Sci Monit. 2014 Mar 8;20:386-92. doi: 10.12659/MSM.890073.
The pleth variability index (PVI) has been demonstrated to be a useful, noninvasive indicator of continuous fluid responsiveness. Whether PVI can be used to assess the changes of intravascular volume status remains to be elucidated.
Using correlation analysis and receiver operating characteristic (ROC) curves, we sought a correlation between PVI and the initial distribution volume of glucose (IDVG), evaluating PVI as an indicator of the central extracellular fluid volume after anesthesia induction in patients undergoing elective abdominal surgery.
Strong negative correlations existed between IDVG and PVI (r=-0.72), IDVG, and pulse pressure variation (PPV) (r=-0.73), and between IDVG and systolic pressure variation (SPV) (r=-0.53), P<0.01. Strong positive correlations existed between PPV and PVI (r=0.66), PVI and SPV (r=0.49), and between PPV and SPV (r=0.59), P<0.01. The areas under the ROC curve of IDVG, PVI, and SPV were significantly different from the area under a reference line. The optimal cutoff values (followed by sensitivity and specificity in parentheses) comparable to PPV over 11% as the threshold of hypovolemia were IDVG 94.5 mL/kg (75%, 100%), PVI 13% (91.7%, 77.8%), and SPV 7% (41.7%, 100%).
Our results show that strong correlations exist among IDVG, PVI, PPV, and SPV in the evaluation of volemia. PVI can serve as a useful, noninvasive indicator of continuous central extracellular fluid volume for those patients not requiring invasive hemodynamic monitoring, but needs attention to changes in intravascular volume status for optimal fluid management.
脉搏波变异指数（PVI）已被证明是一种有用的、非侵入性的连续液体反应性指标。PVI是否可用于评估血管内容量状态的变化仍有待阐明。
通过相关性分析和受试者工作特征（ROC）曲线，我们探寻PVI与葡萄糖初始分布容积（IDVG）之间的相关性，将PVI作为择期腹部手术患者麻醉诱导后中心细胞外液容量的指标进行评估。
IDVG与PVI之间存在强负相关（r = -0.72），IDVG与脉压变异（PPV）之间存在强负相关（r = -0.73），IDVG与收缩压变异（SPV）之间存在强负相关（r = -0.53），P < 0.01。PPV与PVI之间存在强正相关（r = 0.66），PVI与SPV之间存在强正相关（r = 0.49），PPV与SPV之间存在强正相关（r = 0.59），P < 0.01。IDVG、PVI和SPV的ROC曲线下面积与参考线下面积有显著差异。与以PPV超过11%作为低血容量阈值相当的最佳截断值（括号内为敏感性和特异性）分别为：IDVG 94.5 mL/kg（75%，100%），PVI 13%（91.7%，77.8%），SPV 7%（41.7%，100%）。
我们的结果表明，在评估血容量时，IDVG、PVI、PPV和SPV之间存在强相关性。对于那些不需要有创血流动力学监测的患者，PVI可作为一种有用的、非侵入性的连续中心细胞外液容量指标，但为了实现最佳液体管理，需要关注血管内容量状态的变化。
