From the *Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and †Department of Anesthesiology and Pain Medicine, Seoul Medical Center, Seoul, Korea.
Anesth Analg. 2017 Oct;125(4):1158-1165. doi: 10.1213/ANE.0000000000002056.
Stroke volume variation (SVV) and pulse pressure variation (PPV) are used as indicators of fluid responsiveness, but little is known about the usefulness of these dynamic preload indicators in thoracic surgery, which involves an open thoracic cavity and 1-lung ventilation (OLV). Therefore, we investigated whether SVV and PPV could predict fluid responsiveness, and whether the thresholds of these parameters should be adjusted for thoracic surgery.
This was a prospective, controlled study conducted in a tertiary care center. Eighty patients scheduled for an elective lobectomy requiring OLV were included (n = 40, video-assisted thoracoscopic surgery (VATS); n = 40, open thoracotomy). Twenty minutes after opening the thoracic cavity, 7 mL/kg hydroxyethyl starch was administered for 30 minutes. Various hemodynamic parameters were measured before and after fluid challenge.
Among the 80 patients enrolled in this study, 37% were fluid responders (increase in stroke volume index ≥10%). SVV before fluid challenge was not different between nonresponders and responders (mean ± SD: 7.1 ± 2.7% vs 7.4 ± 2.6%, P = .68). This finding was true regardless of whether the surgery involved open thoracotomy or VATS. PPV before fluid challenge showed the difference between nonresponders and responders (mean ± SD: 6.9 ± 3.0% vs 8.4 ± 3.2%; P = .045); however, the sensitivity and specificity of the threshold value (PPV = 7%) were low (58% and 62%, respectively) and the area under the receiver operating characteristics curve was only 0.63 (95% confidence interval, 0.52-0.74; P = .041).
Dynamic preload indicators are not useful for predicting fluid responsiveness in VATS or open thoracic surgery.
每搏量变异（SVV）和脉压变异（PPV）被用作液体反应性的指标，但对于涉及开胸和单肺通气（OLV）的胸外科手术，这些动态前负荷指标的有用性知之甚少。因此，我们研究了 SVV 和 PPV 是否可以预测液体反应性，以及这些参数的阈值是否应该针对胸外科手术进行调整。
这是一项在三级医疗中心进行的前瞻性、对照研究。共纳入 80 例择期行 OLV 肺叶切除术的患者（n=40，电视辅助胸腔镜手术（VATS）；n=40，开胸手术）。开胸后 20 分钟，给予 7 mL/kg 羟乙基淀粉 30 分钟。在液体冲击前后测量各种血流动力学参数。
在这项研究中，80 例患者中有 37%为液体反应者（每搏量指数增加≥10%）。液体冲击前 SVV 在无反应者和反应者之间无差异（均数±标准差：7.1±2.7%与 7.4±2.6%，P=.68）。无论手术是开胸手术还是 VATS，结果均如此。液体冲击前 PPV 显示无反应者和反应者之间的差异（均数±标准差：6.9±3.0%与 8.4±3.2%；P=.045）；然而，阈值（PPV=7%）的敏感性和特异性均较低（分别为 58%和 62%），接受者操作特征曲线下面积仅为 0.63（95%置信区间，0.52-0.74；P=.041）。
在 VATS 或开胸手术中，动态前负荷指标对预测液体反应性没有帮助。
