中区域血浆脑利钠肽前体和每搏量反应性检测大腹部手术后中心血容量的偏差。

Mid-regional plasma pro-atrial natriuretic peptide and stroke volume responsiveness for detecting deviations in central blood volume following major abdominal surgery.

机构信息

Department of Surgery and Transplantation, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Department of Anesthesia, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

出版信息

Acta Anaesthesiol Scand. 2022 Oct;66(9):1061-1069. doi: 10.1111/aas.14126. Epub 2022 Sep 7.

DOI:10.1111/aas.14126

PMID:36069352

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9543860/

Abstract

BACKGROUND

A reduced central blood volume is reflected by a decrease in mid-regional plasma pro-atrial natriuretic peptide (MR-proANP), a stable precursor of ANP, and a volume deficit may also be assessed by the stroke volume (SV) response to head-down tilt (HDT). We determined plasma MR-proANP during major abdominal procedures and evaluated whether the patients were volume responsive by the end of the surgery, taking the fluid balance and the crystalloid/colloid ratio into account.

METHODS

Patients undergoing pancreatic (n = 25), liver (n = 25), or gastroesophageal (n = 38) surgery were included prospectively. Plasma MR-proANP was determined before and after surgery, and the fluid response was assessed by the SV response to 10 HDT after the procedure. The fluid strategy was based mainly on lactated Ringer's solution for gastroesophageal procedures, while for pancreas and liver surgery, more human albumin 5% was administered.

RESULTS

Plasma MR-proANP decreased for patients undergoing gastroesophageal surgery (-9% [95% CI -3.2 to -15.3], p = .004) and 10 patients were fluid responsive by the end of surgery (∆SV > 10% during HDT) with an administered crystalloid/colloid ratio of 3.3 (fluid balance +1389 ± 452 ml). Furthermore, plasma MR-proANP and fluid balance were correlated (r = .352 [95% CI 0.031-0.674], p < .001). In contrast, plasma MR-proANP did not change significantly during pancreatic and liver surgery during which the crystalloid/colloid ratio was 1.0 (fluid balance +385 ± 478 ml) and 1.9 (fluid balance +513 ± 381 ml), respectively. For these patients, there was no correlation between plasma MR-proANP and fluid balance, and no patient was fluid responsive.

CONCLUSION

Plasma MR-proANP was reduced in fluid responsive patients by the end of surgery for the patients for whom the fluid strategy was based on more lactated Ringer's solution than human albumin 5%.

摘要

背景

中区域血浆前心房利钠肽（MR-proANP）的减少反映了中心血容量减少，MR-proANP 是 ANP 的稳定前体，而容量不足也可以通过头低位倾斜（HDT）时的每搏量（SV）反应来评估。我们在进行大型腹部手术期间测定了血浆 MR-proANP，并评估了在手术结束时患者是否通过液体平衡和晶体/胶体比值来响应液体治疗。

方法

前瞻性纳入了 25 例胰腺手术、25 例肝脏手术和 38 例胃食管手术患者。手术前后测定了血浆 MR-proANP，并通过术后 10 次 HDT 评估 SV 反应来评估液体反应。液体策略主要基于乳酸林格氏液用于胃食管手术，而对于胰腺和肝脏手术，更多地给予人白蛋白 5%。

结果

胃食管手术患者的血浆 MR-proANP 降低（-9%[95%CI-3.2 至-15.3]，p=0.004），10 例患者在手术结束时对液体有反应（HDT 期间 SV 增加超过 10%），晶体/胶体比值为 3.3（液体平衡+1389±452ml）。此外，血浆 MR-proANP 和液体平衡呈正相关（r=0.352[95%CI0.031-0.674]，p<0.001）。相比之下，胰腺和肝脏手术期间血浆 MR-proANP 变化不显著，晶体/胶体比值分别为 1.0（液体平衡+385±478ml）和 1.9（液体平衡+513±381ml），并且这些患者血浆 MR-proANP 与液体平衡之间没有相关性，也没有患者对液体有反应。