University of Texas Medical Branch, Galveston, TX.
Baylor Scott & White Healthcare, Temple, TX.
J Cardiothorac Vasc Anesth. 2019 Aug;33(8):2208-2215. doi: 10.1053/j.jvca.2019.01.007. Epub 2019 Jan 4.
Identifying fluid responsiveness is critical to optimizing perfusion while preventing fluid overload. An experimental study of hypovolemic shock resuscitation showed the importance of ventricular compliance and peripheral venous pressure (PVP) on fluid responsiveness. The authors tested the hypothesis that reduced ventricular compliance measured using transesophageal echocardiography results in decreased fluid responsiveness after a fluid bolus.
Prospective observational study.
Two-center, university hospital study.
The study comprised 29 patients undergoing elective coronary revascularization.
Albumin 5%, 7 mL/kg, was infused over 10 minutes to characterize fluid responders (>15% increase in stroke volume) from nonresponders.
Invasive hemodynamics and the ratio of mitral inflow velocity (E-wave)/annular relaxation (e'), or E/e' ratio, were measured using transesophageal echocardiography to assess left ventricular (LV) compliance at baseline and after albumin infusion. Fifteen patients were classified as responders and 14 as nonresponders. The E/e' ratio in responders was 7.4 ± 1.9 at baseline and 7.1 ± 1.8 after bolus. In contrast, E/e' was significantly higher in nonresponders at baseline (10.7 ± 4.6; p = 0.04) and further increased after bolus (12.6 ± 5.5; p = 0.002). PVP was significantly greater in the nonresponders at baseline (14 ± 4 mmHg v 11 ± 3 mmHg; p = 0.02) and increased in both groups after albumin infusion. Fluid responsiveness was tested using the area under the receiver operating characteristic curve and was 0.74 for the E/e' ratio (95% confidence interval 0.55-0.93; p = 0.029) and 0.72 for the PVP (95% confidence interval 0.52-0.92; p = 0.058).
Fluid responders had normal LV compliance and lower PVP at baseline. In contrast, nonresponders had reduced LV compliance, which worsened after fluid bolus. E/e,' more than PVP, may be a useful clinical index to predict fluid responsiveness.
确定液体反应性对于优化灌注和防止液体超负荷至关重要。一项关于低血容量性休克复苏的实验研究表明，心室顺应性和外周静脉压（PVP）对液体反应性的重要性。作者测试了这样一个假设，即使用经食管超声心动图测量的心室顺应性降低会导致液体负荷后液体反应性降低。
前瞻性观察研究。
两个中心的大学医院研究。
这项研究包括 29 名接受择期冠状动脉血运重建的患者。
在 10 分钟内输注白蛋白 5%，7ml/kg，以确定液体反应者（每搏量增加>15%）和非反应者。
使用经食管超声心动图测量有创血流动力学和二尖瓣血流速度（E 波）/环舒张（e'）的比值，或 E/e'比值，以评估左心室（LV）顺应性在基线和白蛋白输注后的变化。15 例患者被归类为反应者，14 例为非反应者。反应者的 E/e'比值在基线时为 7.4±1.9，在输液后为 7.1±1.8。相比之下，非反应者的 E/e'在基线时明显更高（10.7±4.6；p=0.04），输液后进一步升高（12.6±5.5；p=0.002）。非反应者的 PVP 在基线时明显更高（14±4mmHg 比 11±3mmHg；p=0.02），两组在白蛋白输注后均升高。使用受试者工作特征曲线下的面积来测试液体反应性，E/e'比值为 0.74（95%置信区间 0.55-0.93；p=0.029），PVP 为 0.72（95%置信区间 0.52-0.92；p=0.058）。
反应者的左心室顺应性正常，基线时 PVP 较低。相比之下，非反应者的左心室顺应性降低，输液后进一步恶化。E/e'比 PVP 更能预测液体反应性。
