评估心脏手术患者容量负荷操作后桡动脉脉压对每搏量变化检测的影响。

Evaluation of radial artery pulse pressure effects on detection of stroke volume changes after volume loading maneuvers in cardiac surgical patients.

作者信息

Hou Jun-Yi, Zheng Ji-Li, Ma Guo-Guang, Lin Xiao-Ming, Hao Guang-Wei, Su Ying, Luo Jing-Chao, Liu Kai, Luo Zhe, Tu Guo-Wei

机构信息

Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.

Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.

出版信息

Ann Transl Med. 2020 Jun;8(12):787. doi: 10.21037/atm-20-847.

DOI:10.21037/atm-20-847

PMID:32647712

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7333092/

Abstract

BACKGROUND

Fluid responsiveness is defined as an increase in cardiac output (CO) or stroke volume (SV) of >10-15% after fluid challenge (FC). However, CO or SV monitoring is often not available in clinical practice. The aim of this study was to evaluate whether changes in radial artery pulse pressure (rPP) induced by FC or passive leg raising (PLR) correlates with changes in SV in patients after cardiac surgery.

METHODS

This prospective observational study included 102 patients undergoing cardiac surgery, in which rPP and SV were recorded before and immediately after a PLR test and FC with 250 mL of Gelofusine for 10 min. SV was measured using pulse contour analysis. Patients were divided into responders (≥15% increase in SV after FC) and non-responders. The hemodynamic variables between responders and non-responders were analyzed to assess the ability of rPP to track SV changes.

RESULTS

A total of 52% patients were fluid responders in this study. An rPP increase induced by FC was significantly correlated with SV changes after a FC (ΔSV-FC, r=0.62, P<0.01). A ﬂuid-induced increase in rPP (ΔrPP-FC) of >16% detected a ﬂuid-induced increase in SV of >15%, with a sensitivity of 91% and a speciﬁcity of 73%. The area under the receiver operating characteristic curve (AUROC) for the ﬂuid-induced changes in rPP identified fluid responsiveness was 0.881 (95% CI: 0.802-0.937). A grey zone of 16-34% included 30% of patients for ΔrPP-FC. The ΔrPP-PLR was weakly correlated with ΔSV-FC (r=0.30, P<0.01). An increase in rPP induced by PLR (ΔrPP-PLR) predicted fluid responsiveness with an AUROC of 0.734 (95% CI: 0.637-0.816). A grey zone of 10-23% included 52% of patients for ΔrPP-PLR.

CONCLUSIONS

Changes in rPP might be used to detect changes in SV via FC in mechanically ventilated patients after cardiac surgery. In contrast, changes in rPP induced by PLR are unreliable predictors of fluid responsiveness.

摘要

背景

液体反应性定义为液体负荷试验（FC）后心输出量（CO）或每搏输出量（SV）增加>10 - 15%。然而，临床实践中常常无法进行CO或SV监测。本研究的目的是评估FC或被动抬腿试验（PLR）引起的桡动脉脉压（rPP）变化与心脏手术后患者SV变化之间是否存在相关性。

方法

这项前瞻性观察性研究纳入了102例接受心脏手术的患者，在PLR试验和用250 mL贺斯进行10分钟的FC前后记录rPP和SV。使用脉搏轮廓分析法测量SV。患者分为反应者（FC后SV增加≥15%）和无反应者。分析反应者和无反应者之间的血流动力学变量，以评估rPP追踪SV变化的能力。

结果

本研究中共有52%的患者为液体反应者。FC引起的rPP增加与FC后的SV变化显著相关（ΔSV - FC，r = 0.62，P < 0.01）。检测到FC引起的rPP增加（ΔrPP - FC）>16%时，FC引起的SV增加>15%，敏感性为91%，特异性为73%。FC引起的rPP变化识别液体反应性的受试者工作特征曲线下面积（AUROC）为0.881（95% CI：0.802 - 0.937）。16 - 34%的灰色区域包括30%的ΔrPP - FC患者。ΔrPP - PLR与ΔSV - FC弱相关（r = 0.30，P < 0.01）。PLR引起的rPP增加（ΔrPP - PLR）预测液体反应性的AUROC为0.734（95% CI：0.637 - 0.816）。10 - 23%的灰色区域包括52%的ΔrPP - PLR患者。