由肺部招募诱导的血液动力学变化 - 机动预测儿童在一次肺透气期间的液体反应 - 一项前性观察研究
1Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai 200127, China.
Children (Basel, Switzerland)
|June 27, 2024
概括
肺部招募机动 (LRM) 在儿科患者中改变了中风体积 (SV). 在LRM后SV的变化可靠地预测了单肺通风 (OLV) 期间的流体反应.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 麻醉学 麻醉学
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 准确的流体响应预测对于管理重症儿科患者至关重要,防止流体过载或不足.
- 肺部招募机动 (LRM) 和单肺通风 (OLV) 在儿科心脏外科手术中很常见.
- 儿童OLV期间LRM对流体反应预测的影响尚不清楚.
研究的目的:
- 在接受OLV的儿科患者中使用血液动力学参数研究LRM对流体响应可预测性的影响.
- 为了确定LRM后中风体积 (SV) 或平均动脉压 (MAP) 的变化是否可以预测流体响应.
主要方法:
- 研究了34名接受心脏手术的儿童 (1-6岁),接受了OLV和肺部保护性通风.
- 连续执行了LRM和体积扩张 (VE).
- 在LRM和VE之前和之后记录了包括SV和MAP在内的血液动力学参数.
- 流体响应被定义为VE后SV或MAP≥10%的增加.
- 用接收器操作特征 (ROC) 曲线来评估 ΔSVLRM 和 ΔMAPLRM 的预测值.
主要成果:
- 在LRM后,SV显著下降,并在VE后恢复到基线 (p < 0.01).
- 流体响应者 (n=16) 与非响应者相比,在LRM后的VS显著较低.
- ΔSVLRM在预测流体响应性方面表现出高可靠性 (AUC = 0.828,p < 0.001).
- ΔMAPLRM并不能可靠地预测流体反应 (p = 0.07).
结论:
- 肺部招募机动 (ΔSVLRM) 后中风体积的变化是儿科患者在单肺通风期间流体反应的可靠预测指标.
- 在LRM (ΔMAPLRM) 后的平均动脉压变化没有被发现是可靠的预测指标.
- 这些发现可以帮助儿童手术患者在流体管理方面的临床决策.
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