动态变量可预测接受神经外科手术的学龄前和学龄儿童的液体反应性：一项前瞻性观察研究。
Dynamic variables predict fluid responsiveness in pre-school and school children undergoing neurosurgery: a prospective observational study.
作者信息
Song Lin-Lin, Geng Zhi-Yu, Ma Wei, Liu Ya-Fei, Wang Dong-Xin
机构信息
Department of Anesthesiology, Peking University First Hospital, Beijing, China.
Department of Cardiology, Peking University First Hospital, Beijing, China.
出版信息
Transl Pediatr. 2021 Nov;10(11):2972-2984. doi: 10.21037/tp-21-281.
BACKGROUND
The evidence that plethysmographic variability index (PVI), pulse pressure variation (PPV), FloTrac/Vigileo-derived stroke volume variation (SVV), and Ea (dynamic arterial elastance) predict fluid responsiveness in children is limited by conflicting results. We aim to evaluate their accuracy and reliability to predict fluid responsiveness after induction in children aged 4-9 years undergoing major neurosurgery.
METHODS
Children aged 4-9 years undergoing intracranial epileptic foci excision were enrolled. After the induction of anesthesia, fluid loading with 10 mL/kg of Ringer's solution over 10 min was administered before surgical incision. PVI, PPV, SVV, and Ea were measured before and within 5 min after fluid loading. Respiratory variation in aortic blood flow peak velocity (∆Vpeak) >15% at baseline, measured using transthoracic echocardiography, identified fluid "responders". The abilities of dynamic variables to predict an increase in mean arterial pressure (MAP) of >10% following fluid loading were also assessed.
RESULTS
Fourteen (31.8%) of forty-four patients were responders defined by a baseline ∆Vpeak >15%. Before fluid loading, only the PVI value was significantly different between R and NR (P=0.017). Baseline PVI showed fair diagnostic accuracy for fluid responsiveness, with an area under the curve (AUROC) of 0.735 and the cutoff value of 13%. The R group showed a significantly greater absolute change in PPV and SVV after fluid loading from baseline compared with the NR group (P=0.021 and 0.040, respectively). The absolute change in the PPV and SVV values from baseline was greater in R than those in NR (P=0.021 and 0.040, respectively). Twenty (45.5%) showed a MAP increase of >10% following fluid loading and were defined as responders. Baseline ∆Vpeak and SVV showed fair predictive values for a MAP increase of >10% (AUROC =0.758 and 0.715, respectively).
CONCLUSIONS
PVI at baseline showed fair reliability to predict fluid responsiveness after anesthesia induction in mechanically ventilated children aged 4-9 years undergoing neurosurgery. Baseline ∆Vpeak and SVV were fairly predictive for an increase in MAP following fluid loading.
背景
体积描记变异指数（PVI）、脉压变异（PPV）、基于FloTrac/Vigileo监测的每搏量变异（SVV）以及动态动脉弹性（Ea）预测儿童液体反应性的证据因结果相互矛盾而受限。我们旨在评估它们在4至9岁接受大型神经外科手术儿童麻醉诱导后预测液体反应性的准确性和可靠性。
方法
纳入4至9岁接受颅内癫痫病灶切除的儿童。麻醉诱导后，在手术切口前10分钟内给予10 mL/kg林格液进行液体负荷试验。在液体负荷试验前及试验后5分钟内测量PVI、PPV、SVV和Ea。使用经胸超声心动图测量基线时主动脉血流峰值速度的呼吸变异（∆Vpeak）>15%来确定液体“反应者”。还评估了动态变量预测液体负荷后平均动脉压（MAP）升高>10%的能力。
结果
44例患者中有14例（31.8%）根据基线∆Vpeak>15%被定义为反应者。在液体负荷试验前，反应者（R）和无反应者（NR）之间只有PVI值存在显著差异（P = 0.017）。基线PVI对液体反应性显示出较好的诊断准确性，曲线下面积（AUROC）为0.735，截断值为13%。与NR组相比，R组在液体负荷试验后PPV和SVV相对于基线的绝对变化显著更大（分别为P = 0.021和0.040）。R组中PPV和SVV相对于基线的绝对值变化大于NR组（分别为P = 0.021和0.040）。20例（45.5%）患者在液体负荷试验后MAP升高>10%，被定义为反应者。基线∆Vpeak和SVV对MAP升高>10%显示出较好的预测价值（AUROC分别为0.758和0.715）。
结论
基线PVI在预测4至9岁接受神经外科手术的机械通气儿童麻醉诱导后的液体反应性方面显示出较好的可靠性。基线∆Vpeak和SVV对液体负荷后MAP升高具有较好的预测性。
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