Wang Q S, Zhou Y F, Wang C H, Xia Y, Li J, Yuan K M
Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China.
Department of Anesthesiology, Zhoushan Women and Children Hospital, Zhoushan 330902, China.
Zhonghua Yi Xue Za Zhi. 2020 Nov 24;100(43):3425-3430. doi: 10.3760/cma.j.cn112137-20200521-01608.
To evaluate the influence of preoperative fasting duration on blood volume status of pediatric patients during induction based on ultrasonic technique. One hundred and ten pediatric patients, scheduled for elective operation in the Second Affiliated Hospital & Yuying Children's Hospital, were recruited during January and October in 2018. After sedation by inhalation of sevoflurane, the maximum (expiratory) and minimum (inspiratory) diameter of inferior vena cava (IVC(max), IVC(min)) and aorta velocity-time integral (VTI) in apical five-chamber cardiac view were measured with an ultrasound machine. Respiratory variabilities of these parameters were further calculated. Furthermore, passive leg raising (PLR) test was performed and above measurements/calculations were repeated. The correlation between the duration of fasting and IVC respiratory variations index (IVC(RVI)) or aortic VTI variability (ΔVTI) was then analyzed. Before PLR, IVC(max), IVC(min) and IVC(RVI) were (0.78±0.19), (0.43±0.15) cm and 0.45±0.12, respectively. After PLR, IVC(max) and IVC(min) increased to (0.94±0.20), (0.55±0.18) cm, while IVC(RVI) decreased to 0.42±0.13, the differences were statistically significant (15.66, 10.85, 3.14, all 0.05). However, IVC(max), IVC(min) and IVC(RVI) were not significantly correlated with the duration of fasting analyzed by linear regression (before PLR: 0.052, 0.163, 0.171; after PLR, 0.062, 0.169, 0.165, all 0.05). Before PLR, expiratory aortic VTI (VTI(max)), inspiratory aortic VTI (VTI(min)) and ΔVTI were 21±5, 17±4 and 17±8, respectively. After PLR, the VTI(max) and VTI(min) significantly increased to 23±5 and 19±4 (13.60, 10.43, all 0.05), but ΔVTI was not changed significantly, which was 17±8(0.34, 0.05). Linear regression analysis showed that VTI(max), VTI(min) and ΔVTI were not significantly correlated with the duration of fasting (before PLR: 0.111, 0.100, 0.047; after PLR: 0.003, 0.033, 0.073, all 0.05). Further multiple linear regression analysis indicated that, age and body weight were independent factors influencing IVC(RVI) and ΔVTI before and after PLR (IVC(RVI): β=-0.441, 0.515, -0.451, 0.507; ΔVTI: β=-0.442, 0.545, -2.422, 2.850; all 0.05). However, the duration of fasting was not correlated with IVC(RVI) and ΔVTI after adjusting the age and weight (IVC(RVI): β=0.177, 0.160; ΔVTI: β=0.037, 0.054; all 0.05). Age and weight, but not preoperative fasting duration, are correlated with respiratory variabilities of inferior vena cava diameter and aortic VTI in pediatric patients.
基于超声技术评估术前禁食时间对小儿患者诱导期血容量状态的影响。2018年1月至10月，选取在附属第二医院和育英儿童医院计划进行择期手术的110例小儿患者。吸入七氟醚镇静后，用超声仪测量下腔静脉最大（呼气末）和最小（吸气末）直径（IVC(max)，IVC(min)）以及心尖五腔心切面主动脉速度时间积分（VTI）。进一步计算这些参数的呼吸变异性。此外，进行被动抬腿（PLR）试验，并重复上述测量/计算。然后分析禁食时间与下腔静脉呼吸变异指数（IVC(RVI)）或主动脉VTI变异性（ΔVTI）之间的相关性。PLR前，IVC(max)、IVC(min)和IVC(RVI)分别为（0.78±0.19）、（0.43±0.15）cm和0.45±0.12。PLR后，IVC(max)和IVC(min)增加至（0.94±0.20）、（0.55±0.18）cm，而IVC(RVI)降至0.42±0.13，差异有统计学意义（分别为15.66、10.85、3.14，均P<0.05）。然而，通过线性回归分析，禁食时间与IVC(max)、IVC(min)和IVC(RVI)无显著相关性（PLR前：P=0.052、0.163、0.171；PLR后：P=0.062、0.169、0.165，均P>0.05）。PLR前，呼气末主动脉VTI（VTI(max)）、吸气末主动脉VTI（VTI(min)）和ΔVTI分别为21±5、17±4和17±8。PLR后，VTI(max)和VTI(min)显著增加至23±5和19±4（分别为13.60、10.43，均P<0.05），但ΔVTI无显著变化，为17±8（P=0.34，P>0.05）。线性回归分析显示，禁食时间与VTI(max)、VTI(min)和ΔVTI无显著相关性（PLR前：P=0.111、0.100、0.047；PLR后：P=0.003、0.033、0.073，均P>0.05）。进一步的多元线性回归分析表明，年龄和体重是影响PLR前后IVC(RVI)和ΔVTI的独立因素（IVC(RVI)：β=-0.441、0.515、-0.451、0.507；ΔVTI：β=-0.442、0.545、-2.422、2.850；均P<0.05）。然而，调整年龄和体重后，禁食时间与IVC(RVI)和ΔVTI无相关性（IVC(RVI)：β=0.177、0.160；ΔVTI：β=0.037、0.054；均P>0.05）。年龄和体重与小儿患者下腔静脉直径呼吸变异性和主动脉VTI相关，而术前禁食时间无关。
