Kim Hye-Bin, Soh Sarah, Song Jong-Wook, Kim Min-Yu, Kwak Young-Lan, Shim Jae-Kwang
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea.
J Clin Med. 2021 Apr 27;10(9):1886. doi: 10.3390/jcm10091886.
We investigated the role of echocardiographic indices consisting of left ventricular end-diastolic area (LVEDA) in combination with Doppler-derived surrogates of diastolic compliance and filling (E/E', E'/S', E'/A'; early transmitral flow velocity (E), tissue Doppler-derived early (E') diastolic, late (A') diastolic, or peak systolic (S') velocity of the mitral annulus) in predicting fluid responsiveness in off-pump coronary surgery. Hemodynamic and echocardiographic variables were prospectively assessed under general anesthesia before and after a fluid challenge of 6 mL/kg during apnea at atmospheric pressure in 64 patients with LV ejection fraction ≥40%. Forty patients (63%) were fluid responders (≥15% increase in stroke volume index). E/E' and E'/S' could predict fluid responsiveness with area under the receiver operating characteristic curve (AUROC) of 0.71 (95% confidence interval [CI], 0.56-0.85; = 0.006) and 0.68 (95% CI, 0.54-0.82; = 0.017), respectively. The combination of LVEDA and E/E' showed incremental predictive ability for fluid responsiveness compared with LVEDA (AUROC, 0.60; = 0.170) or pulse pressure variation (AUROC, 0.70; = 0.002), yielding the highest AUROC of 0.78 (95% CI, 0.66-0.90; < 0.001). The combined index of echocardiographic variables reflecting LV dimension (LVEDA) and diastolic compliance and filling (E/E') is a potentially useful predictor of fluid responsiveness.
我们研究了由左心室舒张末期面积（LVEDA）与舒张顺应性和充盈的多普勒衍生替代指标（E/E'、E'/S'、E'/A'；二尖瓣血流早期流速（E）、二尖瓣环组织多普勒衍生的舒张早期（E'）、舒张晚期（A'）或收缩期峰值（S'）流速）组成的超声心动图指标在非体外循环冠状动脉手术中预测液体反应性的作用。在64例左心室射血分数≥40%的患者中，于常压下呼吸暂停期间给予6 mL/kg液体负荷前后，在全身麻醉下对血流动力学和超声心动图变量进行前瞻性评估。40例患者（63%）为液体反应者（每搏量指数增加≥15%）。E/E'和E'/S'能够预测液体反应性，受试者工作特征曲线下面积（AUROC）分别为0.71（95%置信区间[CI]，0.56 - ；0.85；P = 0.006）和0.68（95% CI，0.54 - 0.82；P = 0.017）。与LVEDA（AUROC，0.60；P = 0.170）或脉压变异（AUROC，0.70；P = 0.002）相比，LVEDA与E/E'的组合对液体反应性具有更高的预测能力，AUROC最高达0.78（95% CI，0.66 - 0.90；P < 0.001）。反映左心室大小（LVEDA）以及舒张顺应性和充盈（E/E'）的超声心动图变量的联合指标是液体反应性的一个潜在有用预测指标。
