Chin Ji-Hyun, Kim Wook-Jong, Choi Jeong-Hyun, Han Yun A, Kim Seon-Ok, Choi Woo-Jong
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
PLoS One. 2015 Nov 3;10(11):e0142125. doi: 10.1371/journal.pone.0142125. eCollection 2015.
The FloTrac/Vigileo™ system does not thoroughly reflect variable arterial tones, due to a lack of external calibration. The ability of this system to measure stroke volume and track its changes after fluid administration has not been fully evaluated in patients with the high systemic vascular resistance that can develop during laparoscopic surgery.
In 42 patients undergoing laparoscopic prostatectomy, the stroke volume derived by the third-generation FloTrac/Vigileo™ system (SV-Vigileo), the stroke volume measured using transesophageal echocardiography (SV-TEE) as a reference method, and total systemic vascular resistance were evaluated before and after 500 ml fluid administration during pneumoperitoneum combined with the Trendelenburg position.
Total systemic vascular resistance was 2159.4 ± 523.5 dyn·s/cm5 before fluid administration. The SV-Vigileo was significantly higher than the SV-TEE both before (68.8 ± 15.9 vs. 57.0 ± 11.0 ml, P < 0.001) and after (73.0 ± 14.8 vs. 64.9 ± 12.2 ml, P = 0.003) fluid administration. During pneumoperitoneum combined with the Trendelenburg position, Bland-Altman analysis for repeated measures showed a 53.8% of percentage error between the SV-Vigileo and the SV-TEE. Four-quadrant plot (69.2% of a concordance rate) and polar plot analysis (20.6° of a mean polar angle, 16.4° of the SD of a polar angle, and ±51.5° of a radial sector containing 95% of the data points) did not indicate a good trending ability of the FloTrac/Vigileo™ system.
The third-generation FloTrac/Vigileo™ system may not be useful in patients undergoing laparoscopic surgery, based on unreliable performance in measuring the stroke volume and in tracking changes in the stroke volume after fluid administration during pneumoperitoneum combined with the Trendelenburg position.
由于缺乏外部校准，FloTrac/Vigileo™系统不能充分反映动脉张力的变化。在腹腔镜手术过程中可能出现高全身血管阻力的患者中，该系统测量每搏量及其在液体输注后变化的能力尚未得到充分评估。
在42例行腹腔镜前列腺切除术的患者中，评估在气腹联合头低脚高位期间输注500 ml液体前后，第三代FloTrac/Vigileo™系统得出的每搏量（SV-Vigileo）、作为参考方法使用经食管超声心动图测量的每搏量（SV-TEE）以及总全身血管阻力。
液体输注前总全身血管阻力为2159.4±523.5 dyn·s/cm5。液体输注前（68.8±15.9 vs. 57.0±11.0 ml，P<0.001）和输注后（73.0±14.8 vs. 64.9±12.2 ml，P = 0.003），SV-Vigileo均显著高于SV-TEE。在气腹联合头低脚高位期间，对重复测量进行的Bland-Altman分析显示，SV-Vigileo与SV-TEE之间的百分比误差为53.8%。四象限图（一致性率为69.2%）和极坐标图分析（平均极角为20.6°，极角标准差为16.4°，包含95%数据点的径向扇区为±51.5°）未显示FloTrac/Vigileo™系统具有良好的趋势跟踪能力。
基于在气腹联合头低脚高位期间测量每搏量以及跟踪液体输注后每搏量变化方面的不可靠表现，第三代FloTrac/Vigileo™系统可能对行腹腔镜手术的患者无用。
