潮体积挑战引起的血液动力学变化可以预测一个肺通风期间的液体反应:一项观察性研究
Yang Zhang1, Yinyin Ding1, Jiatong Zhang1
1Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou, China.
Frontiers in medicine
|August 28, 2023
概括
潮体积挑战有效地预测了单肺通风期间的流体反应. 动脉冲量和速度时间积分的变化可以识别那些从液体管理中受益的患者.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
背景情况:
- 一个肺通风 (OLV) 提出了独特的血液动力学挑战.
- 预测液体响应对于优化OLV期间的血液动力学至关重要.
研究的目的:
- 评估潮体积挑战 (VTC) 诱导的血液动力学变化在预测流体响应性的有效性.
- 评估在VTC过程中冲击体积 (SV) 和速度时间积分 (VTI) 变化的预测能力.
主要方法:
- 招募了80名接受OLV进行胸腔镜手术的患者.
- 监测了包括LVOT直径,大动脉VTI和SV在内的血液动力学变量.
- 在VTC (5至8毫升/公斤) 期间计算了SV,VTI和平均动脉压 (MAP) 的变化.
- 流体响应被定义为流体管理后SV≥10%的增加.
主要成果:
- 分析了58名患者,其中32名反应者 (55%) 和26名非反应者 (45%).
- 在 ΔSV-VTC 的曲线下面积 (AUC) 为 0.81 和 ΔVTI-VTC 是 0.79.
- 最佳值为 ΔSV-VTC 的 -16.1% (灵敏度为 78.1%,特异性为 84.6%) 和 ΔVTI-VTC 的 -14.5% (灵敏度为 78.1%,特异性为 80.8%).
结论:
- 潮体积挑战引起的SV和VTI变化是OLV期间流体响应的可靠预测指标.
- 这种方法有助于指导OLV患者的流体管理.
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