Guinot Pierre-Grégoire, Bernard Eugenie, Defrancq Fanny, Petiot Sandra, Majoub Yazine, Dupont Herve, Lorne Emmanuel
From the Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, Amiens, France.
Eur J Anaesthesiol. 2015 Sep;32(9):645-9. doi: 10.1097/EJA.0000000000000175.
The ability to predict fluid responsiveness in spontaneously breathing patients under spinal anaesthesia is desirable.
The objective of this study was to test whether variations in stroke volume (SV) in response to a fixed mini-fluid challenge (ΔSV100) measured by thoracic impedance cardiography (ICG) can predict fluid responsiveness in spontaneously breathing patients under spinal anaesthesia.
A prospective observational study.
Anaesthesiology department in a university hospital.
Seventy-three patients monitored by ICG during surgery under spinal anaesthesia.
Patients received a 100 ml fluid challenge followed by volume expansion with 500 ml of crystalloid.
Haemodynamic variables and bioimpedance indices [blood pressure, SV, cardiac output (CO)] were measured before and after fluid challenge and before and after volume expansion. Responders were defined as those with >15% increase in SV after volume expansion.
SV increased by at least 15% in 27 (37%) of the 73 patients. ΔSV100 predicted fluid responsiveness with an area under the receiver operating characteristic (AUC) curve of 0.93 [95% confidence interval (95% CI) 0.8 to 0.97, P < 0.001]. The cut-off was 7% and a grey zone ranging between 3 and 8% was observed in up to 14% of patients. SV baseline was a poor predictor of fluid responsiveness [AUC of 0.69 (95% CI 0.57 to 0.79, P = 0.002)].
ΔSV100 greater than 7% accurately predicted fluid responsiveness during surgery with a grey zone ranging between 3 and 8%.
能够预测脊髓麻醉下自主呼吸患者的液体反应性是很有必要的。
本研究的目的是测试通过胸阻抗心动图（ICG）测量的应对固定小剂量液体冲击（ΔSV100）时每搏量（SV）的变化是否能够预测脊髓麻醉下自主呼吸患者的液体反应性。
一项前瞻性观察性研究。
一家大学医院的麻醉科。
73例在脊髓麻醉下手术期间接受ICG监测的患者。
患者接受100ml液体冲击，随后用500ml晶体液进行容量扩充。
在液体冲击前后以及容量扩充前后测量血流动力学变量和生物阻抗指标[血压、SV、心输出量（CO）]。反应者定义为容量扩充后SV增加>15%的患者。
73例患者中有27例（37%）的SV至少增加了15%。ΔSV100预测液体反应性的受试者工作特征（AUC）曲线下面积为0.93[95%置信区间（95%CI）0.8至0.97，P<0.001]。截断值为7%，在高达14%的患者中观察到3%至8%的灰色区域。SV基线对液体反应性的预测能力较差[AUC为0.69（95%CI 0.57至0.79，P=0.002）]。
大于7%的ΔSV100可准确预测手术期间的液体反应性，灰色区域为3%至8%。
