Kim S-H, Moon Y-J, Kim J-W, Song J-G, Hwang G-S
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Transplant Proc. 2017 Jun;49(5):1082-1086. doi: 10.1016/j.transproceed.2017.03.032.
The fluid management of cirrhotic patients undergoing liver transplantation (LT) is challenging. Phonocardiography, a graphic recording of heart sounds, provides valuable information concerning heart function and hemodynamic condition. We assessed whether the systolic time interval (STI) and its respiratory variation could predict fluid responsiveness in cirrhotic patients undergoing LT.
Thirty LT recipients who needed volume expansion were included. The fluid challenge consisted of 500 mL 5% albumin administered over a period of 10 minutes. STI was measured as the time interval between the maximal amplitude of each heart sound corrected with the corresponding RR interval (cSTI). The respiratory variation in STI (STV) induced by mechanical ventilation was calculated. Responders were defined as those showing a ≥10% increase in stroke volume index after volume expansion.
In all, 14 of the 30 patients were responders. Significant increases in cSTI were observed after volume expansion in both responders (P < .001) and non-responders (P = .008). Responders showed significant decreases in STV (11.1% ± 4.3% vs 6.1% ± 2.6%, P < .001) after fluid loading, whereas STV in non-responders remained unchanged (6.4% ± 2.6% vs 6.4% ± 4.2%, P = .86). A cut-off value of ≥7.5% STV from baseline could predict fluid responsiveness with an area under the receiver operating characteristic curve of 0.804 (95% confidence interval, 0.618-0.925).
Intra-operative STV can predict fluid responsiveness in patients undergoing LT. Beat-to-beat monitoring of STI and STV may be useful as a non-invasive hemodynamic index and for fluid management.
肝移植（LT）肝硬化患者的液体管理具有挑战性。心音图是心音的图形记录，可提供有关心脏功能和血流动力学状况的有价值信息。我们评估了收缩时间间期（STI）及其呼吸变化是否可预测LT肝硬化患者的液体反应性。
纳入30例需要扩容的LT受者。液体负荷试验包括在10分钟内输注500 mL 5%白蛋白。STI测量为每个心音最大振幅与相应RR间期校正后的时间间期（cSTI）。计算机械通气引起的STI呼吸变化（STV）。反应者定义为扩容后每搏量指数增加≥10%的患者。
30例患者中，14例为反应者。反应者（P <.001）和非反应者（P =.008）扩容后cSTI均显著增加。液体负荷后，反应者的STV显著降低（11.1%±4.3%对6.1%±2.6%，P <.001），而非反应者的STV保持不变（6.4%±2.6%对6.4%±4.2%，P =.86）。STV较基线增加≥7.5%的截断值可预测液体反应性，受试者工作特征曲线下面积为0.804（95%置信区间，0.618 - 0.925）。
术中STV可预测LT患者的液体反应性。逐搏监测STI和STV作为一种非侵入性血流动力学指标和用于液体管理可能是有用的。
