Accuracy of lung recruitment maneuver combined with brachial artery peak velocity variation in predicting fluid responsiveness

Qu Min; Yao Zhongyan; Liu Tianlin; Li Jing; Wang Juan; Yan Ning; Yang Qiang; Liu Mingyuan

doi:10.3760/cma.j.issn.0254-1416.2020.02.023

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• 容量治疗与血液保护 •

肺复张联合肱动脉峰流速变异度预测患者术中容量反应性的准确性

中华麻醉学杂志, 2020,40(02) : 217-220. DOI: 10.3760/cma.j.issn.0254-1416.2020.02.023

摘要

目的

评价肺复张联合肱动脉峰流速变异度(ΔVp)预测患者术中容量反应性的准确性。

方法

择期全麻下行开腹胃肠手术患者64例，年龄18～64岁，性别不限，BMI 19～26 kg/m²，ASA分级Ⅰ或Ⅱ级，NYHA分级Ⅰ或Ⅱ级。麻醉诱导后依次进行肺复张(保持30 cmH₂O气道正压10 s)和容量负荷试验。于肺复张开始时采用超声测量ΔVp。于肺复张前(T₁)、肺复张时(T₂)、容量负荷前(T₃)、容量负荷后(T₄)记录MAP、HR、CVP、SV，计算各指标肺复张前后变化率(ΔMAP_LRM、ΔHR_LRM、ΔCVP_LRM、ΔSV_LRM)和容量负荷试验前后变化率(ΔMAP_VE、ΔHR_VE、ΔCVP_VE、ΔSV_VE)。以ΔSV_VE≥15%定义容量负荷试验阳性，分为有反应组(≥15%，R组)和无反应组(<15%，NR组)。

结果

R组34例，NR组30例。与NR组比较，R组T₂时MAP和T_1，2时SV降低，ΔMAP_LRM、ΔMAP_VE、ΔSV_LRM和ΔSV_VE升高，ΔVp升高(P<0.05)。ΔVp与ΔSV_VE呈正相关(r＝0.829，P<0.05)，ΔSV_LRM与ΔSV_VE呈负相关(r＝－0.876，P<0.05)，ΔVp与ΔSV_LRM呈负相关(r＝－0.819，P<0.05)。肺复张联合ΔVp预测患者容量反应性的受试者工作特征曲线下面积为0.808，诊断阈值32.3%，灵敏度75.3%，特异度88.2%。

结论

肺复张联合ΔVp(≥32.3%)可准确预测患者术中容量反应性。

引用本文: 瞿敏, 姚忠岩, 刘天琳, 等. 肺复张联合肱动脉峰流速变异度预测患者术中容量反应性的准确性 [J] . 中华麻醉学杂志,2020,40 (02): 217-220. DOI: 10.3760/cma.j.issn.0254-1416.2020.02.023

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

对患者术中容量反应性的准确评估是液体治疗的基础。容量负荷试验是评估容量反应性的经典方法，然而存在肺水肿等容量负荷过重风险，临床中需寻求更加安全有效的方法。肺复张可利用心肺交互机制进行逆向容量负荷试验，操作简单，不额外增加液体负荷。肺复张联合SV的变化程度可用于预测术中患者容量反应性^[1]，然而SV监测需有创操作和特殊监测仪器。研究表明，超声测量肱动脉峰流速可用于评估重症监护室患者的容量反应性^[2,3]，且方便、无创。肺复张联合肱动脉峰流速是否能进一步提高术中容量反应性评估的准确性还尚待研究。本研究拟评价肺复张联合肱动脉峰流速变异度(ΔVp)预测患者术中容量反应性的准确性，并为临床提供参考。

贡献者信息

瞿敏

沧州市中心医院麻醉科　061001

姚忠岩

沧州市中心医院麻醉科　061001

刘天琳

沧州市中心医院麻醉科　061001

李婧

沧州市中心医院超声科　061001

王娟

沧州市中心医院麻醉科　061001

闫宁

沧州市中心医院麻醉科　061001

杨强

沧州市中心医院麻醉科　061001

刘明远

沧州市中心医院麻醉科　061001

通信作者

瞿敏

沧州市中心医院麻醉科　061001

Email：quminhayida@163.com

关键词

正压通气; 血管容量; 肱动脉; 血流速度;

基金项目

沧州市重点研发计划指导项目（183302045）

利益冲突

利益冲突　所有作者均声明不存在利益冲突

历史

出版日期：2020-02-20

收稿日期：2019-12-20

本文编辑

周晓云

Volume Therapy and Blood Conservation

Accuracy of lung recruitment maneuver combined with brachial artery peak velocity variation in predicting fluid responsiveness

Qu Min, Yao Zhongyan, Liu Tianlin, Li Jing, Wang Juan, Yan Ning, Yang Qiang, Liu Mingyuan

Published 2020-02-20

Cite as Chin J Anesthesiol, 2020,40(02): 217-220. DOI: 10.3760/cma.j.issn.0254-1416.2020.02.023

Abstract

Objective

To evaluate the accuracy of lung recruitment maneuver (LRM) combined with brachial artery peak velocity variation (ΔVp) in predicting fluid responsiveness.

Methods

Sixty-four patients of both sexes, aged 18-64 yr, with body mass index 19-26 kg/m², of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with New York Heart Association class Ⅰor Ⅱ, scheduled for elective open gastrointestinal surgery under general anesthesia, were enrolled in this study.LRM (positive airway pressure was maintained at 30 cmH₂O for 10 s) and volume loading test were performed in sequence after anesthesia induction.ΔVp was measured by ultrasonography at the beginning of LRM.Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) and stroke volume (SV) were recorded before LRM (T₁), during LRM (T₂), before volume expansion (T₃) and after volume expansion (T₄). The changing rate of each index before and after LRM (ΔMAP_LRM, ΔHR_LRM, ΔCVP_LRM, ΔSV_LRM) and before and after volume expansion (ΔMAP_VE, ΔHR_VE, ΔCVP_VE, ΔSV_VE) were calculated.ΔSV_VE≥15% was considered to be a positive response after volume expansion, and patients were divided into response group (≥ 15%, R group) and non-response group (< 15%, NR group).

Results

There were 34 cases in R group and 30 cases in NR group.Compared with NR group, MAP at T₂ and SV at T_{1, 2} were significantly decreased, ΔMAP_LRM, ΔMAP_VE, ΔSV_LRM and ΔSV_VE were increased, and ΔVp was increased in group R (P<0.05). There was a positive correlation between ΔVp and ΔSV_VE (r=0.829, P<0.05), a negative correlation between ΔSV_LRM and ΔSV_VE (r=-0.876, P<0.05), and a negative correlation between ΔVp and ΔSV_LRM (r=-0.819, P<0.05). The area under the receiver operating characteristic curve of LRM combined with ΔVp was 0.808, and the cut-off value was 32.3%, the sensitivity 75.3%, and the specificity 88.2%.

Conclusion

LRM combined with ΔVp (≥32.3%) can accurately predict the intraoperative fluid responsiveness in patients.

Key words:

Positive-pressure respiration; Vascular capacitance; Brachial artery; Blood flow velocity

Contributor Information

Qu Min