头部与指端体积描记变异性指数测量：心脏手术患者的一项对比性初步研究。

Cephalic versus digital plethysmographic variability index measurement: a comparative pilot study in cardiac surgery patients.

作者信息

Fischer Marc-Olivier, Pellissier Arnaud, Saplacan Vladimir, Gérard Jean-Louis, Hanouz Jean-Luc, Fellahi Jean-Luc

机构信息

Departments of *Anesthesia and Critical Care Medicine; University of Caen, Caen, France.

Cardiology.

出版信息

J Cardiothorac Vasc Anesth. 2014 Dec;28(6):1510-5. doi: 10.1053/j.jvca.2014.05.003. Epub 2014 Sep 26.

DOI:10.1053/j.jvca.2014.05.003

PMID:25263772

Abstract

OBJECTIVES

Noninvasive measurement of digital plethysmographic variability index (PVI(digital)) has been proposed to predict fluid responsiveness, with conflicting results. The authors tested the hypothesis that cephalic sites of PVI measurement (namely PVI(ear) and PVI(forehead)) could be more discriminant than PVI(digital) to predict fluid responsiveness after cardiac surgery.

DESIGN

A prospective observational study.

SETTING

A cardiac surgical intensive care unit of a university hospital.

PARTICIPANTS

Fifty adult patients.

INTERVENTIONS

Investigation before and after fluid challenge.

MEASUREMENT AND MAIN RESULTS

Patients were prospectively included within the first 6-hour postoperative period and investigated before and after fluid challenge. A positive response to fluid challenge was defined as a 15% increase in cardiac index. PVI(digital), PVI(ear), PVI(forehead), and invasive arterial pulse-pressure variation (PPV) measurements were recorded simultaneously, and receiver operating characteristic (ROC) curves were built. Forty-one (82%) patients were responders and 9 (18%) patients were nonresponders to fluid challenge. ROCAUC were 0.74 (95% confidence interval [95% CI]: 0.60-0.86), 0.81 (95% CI: 0.68-0.91), 0.88 (95% CI: 0.75-0.95) and 0.87 (95% CI: 0.75-0.95) for PVI(digital), PVI(ear), PVI(forehead), and PPV, respectively. Significant differences were observed between PVI(forehead) and PVI(digital) (absolute difference in ROCAUC = 0.134 [95% CI: 0.003-0.265], p = 0.045) and between PPV and PVI(digital) (absolute difference in ROCAUC = 0.129 [95% CI: 0.011-0.247], p = 0.033). The percentage of patients within the inconclusive class of response was 46%, 70%, 44%, and 26% for PVI(digital), PVI(ear), PVI(forehead), and PPV, respectively.

CONCLUSIONS

PVI(forehead) was more discriminant than PVI(digital) and could be a valuable alternative to arterial PPV in predicting fluid responsiveness.

摘要

目的

已有人提出通过无创测量指端体积描记变异指数（PVI(指端)）来预测液体反应性，但结果存在争议。作者检验了这样一个假设，即测量PVI的头部部位（即PVI(耳部)和PVI(前额)）在预测心脏手术后的液体反应性方面可能比PVI(指端)更具鉴别力。

设计

一项前瞻性观察性研究。

设置

一所大学医院的心脏外科重症监护病房。

参与者

50名成年患者。

干预措施

液体负荷试验前后的研究。

测量与主要结果

患者在术后6小时内被前瞻性纳入研究，并在液体负荷试验前后进行研究。对液体负荷试验的阳性反应定义为心脏指数增加15%。同时记录PVI(指端)、PVI(耳部)、PVI(前额)和有创动脉脉压变异（PPV），并绘制受试者工作特征（ROC）曲线。41名（82%）患者对液体负荷试验有反应，9名（18%）患者无反应。PVI(指端)、PVI(耳部)、PVI(前额)和PPV的ROC曲线下面积（AUROC）分别为0.74（95%置信区间[95%CI]：0.60 - 0.86）、0.81（95%CI：0.68 - 0.91）、0.88（95%CI：0.75 - 0.95）和0.87（95%CI：0.75 - 0.95）。PVI(前额)和PVI(指端)之间（AUROC的绝对差异 = 0.134 [95%CI：0.003 - 0.265]，p = 0.045）以及PPV和PVI(指端)之间（AUROC的绝对差异 = 0.129 [95%CI：0.011 - 0.247]，p = 0.033）观察到显著差异。对于PVI(指端)、PVI(耳部)、PVI(前额)和PPV，反应不确定类患者的百分比分别为46%、70%、44%和26%。