Moon Eun-Jin, Lee Seunghwan, Yi Jae-Woo, Kim Ju Hyun, Lee Bong-Jae, Seo Hyungseok
Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Korea.
Department of Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Korea .
Medicina (Kaunas). 2019 Dec 19;56(1):3. doi: 10.3390/medicina56010003.
: For using appropriate goal-directed fluid therapy during the surgical conditions of pneumoperitoneum in the reverse Trendelenburg position, we investigated the predictability of various hemodynamic parameters for fluid responsiveness by using a mini-volume challenge test. : 42 adult patients scheduled for laparoscopic cholecystectomy were enrolled. After general anesthesia was induced, CO pneumoperitoneum was applied and the patient was placed in the reverse Trendelenburg position. The mini-volume challenge test was carried out with crystalloid 4 mL/kg over 10 min. Hemodynamic parameters, including stroke volume variation (SVV), cardiac index (CI), stroke volume index (SVI), mean arterial pressure (MAP), and heart rate (HR), were measured before and after the mini-volume challenge test. The positive fluid responsiveness was defined as an increase in stroke volume index ≥10% after the mini-volume challenge. For statistical analysis, a Shapiro-Wilk test was used to test the normality of the data. Continuous variables were compared using an unpaired -test or the Mann-Whitney rank-sum test. Categorical data were compared using the chi-square test. A receiver operating characteristic curve analysis was used to assess the predictability of fluid responsiveness after the mini-volume challenge. : 31 patients were fluid responders. Compared with the MAP and HR, the SVV, CI, and SVI showed good predictability for fluid responsiveness after the mini-volume challenge test (area under the curve was 0.900, 0.833, and 0.909, respectively; all -values were <0.0001). : SVV and SVI effectively predicted fluid responsiveness after the mini-volume challenge test in patients placed under pneumoperitoneum and in the reverse Trendelenburg position.
为了在气腹手术且处于头高足低位的情况下使用合适的目标导向液体治疗，我们通过小型容量负荷试验研究了各种血流动力学参数对液体反应性的预测能力。纳入了42例计划行腹腔镜胆囊切除术的成年患者。诱导全身麻醉后，施加二氧化碳气腹并将患者置于头高足低位。在10分钟内以4 mL/kg的晶体液进行小型容量负荷试验。在小型容量负荷试验前后测量血流动力学参数，包括每搏量变异度（SVV）、心脏指数（CI）、每搏量指数（SVI）、平均动脉压（MAP）和心率（HR）。阳性液体反应性定义为小型容量负荷试验后每搏量指数增加≥10%。对于统计分析，使用Shapiro-Wilk检验来检验数据的正态性。连续变量使用未配对t检验或Mann-Whitney秩和检验进行比较。分类数据使用卡方检验进行比较。使用受试者工作特征曲线分析来评估小型容量负荷试验后液体反应性的预测能力。31例患者为液体反应者。与MAP和HR相比，SVV、CI和SVI在小型容量负荷试验后对液体反应性具有良好的预测能力（曲线下面积分别为0.900、0.833和0.909；所有P值均<0.0001）。SVV和SVI在气腹且处于头高足低位的患者中有效地预测了小型容量负荷试验后的液体反应性。
