在胸椎后凸患者中，每搏量变异度和脉压变异度预测液体反应性的准确性。

Accuracy of stroke volume variation and pulse pressure variation to predict fluid responsiveness in patients with thoracic kyphosis.

机构信息

Department of Anesthesiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China.

Department of Anesthesiology, The 900th Hospital of Joint Logistics Support Force, Fuzhou, China.

出版信息

Ann Palliat Med. 2021 Jul;10(7):7571-7578. doi: 10.21037/apm-21-1211. Epub 2021 Jun 21.

DOI:10.21037/apm-21-1211

PMID:34154341

Abstract

BACKGROUND

This study aims to evaluate the ability of stroke volume variation (SVV) and pulse pressure variation (PPV) to predict fluid responsiveness in mechanically ventilated patients with thoracic kyphosis.

METHODS

A total of 35 patients diagnosed with thoracic kyphosis undergoing corrective surgery were studied. For all patients, the Vigileo/FloTrac system was used for analysis. Hemodynamic data such as mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), stroke volume index (SVI), cardiac output (CO), cardiac output index (CI), SVV, and PPV were recorded before and after volume expansion (VE). Fluid responsiveness was defined as an increase in SVI ≥10% (ΔSVI ≥10%). Patients were divided into responders and non-responders as determined by changes in ΔSVI ≥10% and <10%. Nonparametric Wilcoxon rank sum test was used to compare the hemodynamic parameters of Responders and Non-responders before and after VE. Pearson correlation analysis was used to analyze the values of SVV, PPV and ΔSVI. The receiver operating characteristic (ROC) curve of each hemodynamic index was drawn to determine its accuracy and threshold.

RESULTS

Two patients were excluded. There was no significant difference in patients' characteristics between Responders and Non-responders. After VE, there were no significant changes in HR, MAP, and SV in both responders and non-responders, but CI were significantly changed in the two groups. SVI and CO increased significantly in responders before and after VE, but not in non-responders. VE also caused decreases of PPV and SVV in both responders and non-responders. Before VE, the SVV and PPV correlated with ΔSVI in responders (r=0.621, r=0.569, respectively, P<0.05), but neither the SVV nor PPV correlated with ΔSVI in non-responders (P>0.05). The areas under the ROC curves of patients with thoracic kyphosis were 0.872 (95% CI: 0.719-1.000) for SVV and 0.833 (95% CI: 0.667-1.000) for PPV. The threshold of the SVV of patients with thoracic kyphosis was 13.5%, and the threshold of PPV was 14.5%.

CONCLUSIONS

Both SVV and PPV can be used as effective indictors to monitor volume changes in patients with thoracic kyphosis.

摘要

背景

本研究旨在评估每搏量变异（SVV）和脉压变异（PPV）预测胸腰椎后凸畸形机械通气患者液体反应性的能力。

方法

共纳入 35 例诊断为胸腰椎后凸畸形行矫形手术的患者。所有患者均使用 Vigileo/FloTrac 系统进行分析。记录容量扩张（VE）前后的平均动脉压（MAP）、心率（HR）、每搏量（SV）、每搏量指数（SVI）、心输出量（CO）、心输出量指数（CI）、SVV 和 PPV 等血流动力学参数。液体反应性定义为 SVI 增加≥10%（ΔSVI≥10%）。根据ΔSVI≥10%和<10%将患者分为有反应者和无反应者。采用非参数 Wilcoxon 秩和检验比较 VE 前后有反应者和无反应者的血流动力学参数。采用 Pearson 相关分析评估 SVV、PPV 和ΔSVI 的值。绘制每个血流动力学指标的受试者工作特征（ROC）曲线，以确定其准确性和阈值。

结果

排除了 2 例患者。有反应者和无反应者的患者特征无显著差异。VE 后，有反应者和无反应者的 HR、MAP 和 SV 均无显著变化，两组 CI 均有显著变化。VE 后，有反应者的 SVI 和 CO 明显增加，但无反应者无明显变化。VE 还导致有反应者和无反应者的 PPV 和 SVV 均下降。VE 前，SVV 和 PPV 与有反应者的ΔSVI 相关（r=0.621，r=0.569，均 P<0.05），但 SVV 和 PPV 与无反应者的ΔSVI 均不相关（P>0.05）。胸腰椎后凸畸形患者的 ROC 曲线下面积为 SVV 0.872（95%CI：0.719-1.000），PPV 0.833（95%CI：0.667-1.000）。胸腰椎后凸畸形患者 SVV 的阈值为 13.5%，PPV 的阈值为 14.5%。