潮体积变化的影响,以压力为基础,对儿童的流体反应能力进行预测
Sang-Hwan Ji1, Young-Eun Jang1, Jung-Bin Park1
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Paediatric anaesthesia
|August 29, 2023
概括
增加潮体积并不能提高脉冲压变化或心压变化的能力,以预测心脏手术的儿童的液体反应. 这些动态参数对于指导儿科患者的流体治疗仍然不可靠.
科学领域:
- 儿科麻醉学 儿科麻醉学
- 临界护理医学 临界护理医学
- 心血管外科心血管外科
背景情况:
- 脉冲压变化 (PPV) 和静脉压变化 (SPV) 是动态指标,用于预测成年人的液体反应.
- 之前的研究表明,PPV和SPV在儿童中不可靠.
- 在成年人中增加潮体积可以提高PPV和SPV的预测能力.
研究的目的:
- 调查增加潮体积是否可以提高PPV和SPV对儿童液体反应的预测值.
- 评估增强PPV和SPV在儿科心脏手术患者中的可靠性.
主要方法:
- 涉及7岁以下儿童进行心房或心室隔膜缺陷修复的前性研究.
- 记载PPV和SPV的潮量为6,10和14毫升/公斤.
- 在10毫升/千克晶质玻尿酸注射后,通过15%的中风体积指数增加 (通过食管横断心声学测量) 评估了液体反应能力.
主要成果:
- 其中包括26名儿童;15人是响应者.
- 在潮体积为14mL/kg时,PPV和SPV的ROC曲线下的面积分别为0.576 (p=0.517) 和0.548 (p=0.678).
- 在响应者和非响应者之间没有观察到动态参数的显著差异.
结论:
- 增强PPV和SPV,即使在增加的潮体积,也不能可靠地预测儿童在简单的心脏手术后的液体反应.
- 动脉遵守和胸壁遵守的差异可能解释了与成人相比,儿童的无效性.
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