Rathore Abhishek, Singh Shalendra, Lamsal Ritesh, Taank Priya, Paul Debashish
Department of Anaesthesiology, Army R&R Hospital Delhi Cantt, Delhi, India.
Department of Neuroanaesthesiology, All India Institute of Medical Science, New Delhi, India.
Turk J Anaesthesiol Reanim. 2017 Aug;45(4):210-217. doi: 10.5152/TJAR.2017.04568. Epub 2017 Aug 1.
Static monitors for assessing the fluid status during major surgeries and in critically ill patients have been gradually replaced by more accurate dynamic monitors in modern-day anaesthesia practice. Pulse pressure variation (PPV) and systolic pressure variation (SPV) are the two commonly used dynamic indices for assessing fluid responsiveness.
In this prospective observational study, 50 patients undergoing major surgeries were monitored for PPV and SPV: after the induction of anaesthesia and after the administration of 500 mL of isotonic crystalloid bolus. Following the fluid bolus, patients with a cardiac output increase of more than 15% were classified as responders and those with an increase of less than 15% were classified as non-responders.
There were no significant differences in the heart rate (HR), mean arterial pressure (MAP), PPV, SVV, central venous pressure (CVP) and cardiac index (CI) between responders and non-responders. Before fluid bolus, the stroke volume was significantly lower in responders (p=0.030). After fluid bolus, MAP was significantly higher in responders but there were no significant changes in HR, CVP, CI, PPV and SVV. In both responders and non-responders, PPV strongly correlated with SVV before and after fluid bolus.
Both PPV and SVV are useful to predict cardiac response to fluid loading. In both responders and non-responders, PPV has a greater association with fluid responsiveness than SVV.
在现代麻醉实践中，用于评估大手术期间及危重症患者液体状态的静态监测仪已逐渐被更精确的动态监测仪所取代。脉压变异（PPV）和收缩压变异（SPV）是评估液体反应性的两个常用动态指标。
在这项前瞻性观察研究中，对50例接受大手术的患者进行了PPV和SPV监测：在麻醉诱导后以及给予500 mL等渗晶体液冲击量后。给予液体冲击量后，心输出量增加超过15%的患者被归类为反应者，增加少于15%的患者被归类为无反应者。
反应者与无反应者在心率（HR）、平均动脉压（MAP）、PPV、每搏量变异（SVV）、中心静脉压（CVP）和心脏指数（CI）方面无显著差异。在给予液体冲击量前，反应者的每搏量显著较低（p = 0.030）。给予液体冲击量后，反应者的MAP显著较高，但HR、CVP、CI、PPV和SVV无显著变化。在反应者和无反应者中，给予液体冲击量前后PPV与SVV均密切相关。
PPV和SVV均有助于预测心脏对液体负荷的反应。在反应者和无反应者中，PPV与液体反应性的相关性均高于SVV。
