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Trendelenburgの位置は,流体応答性を予測するダイナミック変数の値を下げます
Chih-Chung Wu1,2, Eric Yi-Hsiu Huang3,4, Hui-Hsuan Ke1,5,2
1Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Journal of the Chinese Medical Association : JCMA
|August 24, 2025
まとめ
トレンドレンブルクの位置付けは,ストロークの体積変化 (SVV) とパルス圧力変化 (PPV) を大幅に減少させます. 目標指向の流体療法で使用されるこれらのダイナミックな変数は,異なる傾斜角度で慎重に解釈する必要があります.
科学分野:
- 麻酔科
- クリティカル ケア 医療
- 心血管の生理学
背景:
- 目標指向流体療法 (GDFT) は,脳卒中の体積変化 (SVV) と脈圧変化 (PPV) のような動的変数を使用して,流体投与を最適化します.
- 流体評価のための伝統的な静的パラメータはしばしば不正確です.
- トレンデレンブルクの位置づけが動的血液動力学変数に与える影響は十分に理解されていません.
研究 の 目的:
- SVV,PPV,および他の血液動力学的パラメータに対するトレンドレンブルク傾斜角度の変化の影響を調査する.
- 動的変数が傾斜角度によって予測可能な変化があるかどうかを判断する.
- トレンドレンブルクの位置づけの際にGDFT変数の解釈を参考にする.
主な方法:
- 選択手術を受けた患者を対象とした観察研究.
- 血液動力学的変数 (SVV,PPV,dP/ dt,Eadyn,CI) は,横たわっていた状態 (0°) で記録され,トレンドレンブルクは5°,10°,15°および25°で記録された.
- 変化と相関を評価するために統計分析が行われました.
主要な成果:
- トレンドレンブルクの傾き角を上げると SVVとPPVが著しく減少した.
- SVVとPPVは,すべての傾斜角度での値と有意に相関しています.
- 心臓指数 (CI) と収縮性 (dP/dt) も傾きが増加するにつれて著しく低下した.
結論:
- 流体反応に対するSVVとPPVの予測値は,Trendelenburgの傾きによって変化する.
- これらの動的変数は,GDFTの傾斜角度に関して慎重に解釈する必要があります.
- 臨床的な流体管理の決定は,患者の位置を考慮する必要があります.
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