用三台监视器测量高风险手术患者的脉冲压和中风体积变化的比较
Barbora Cenková1,2,3, Miloš Chobola2, Vladimír Šrámek2,3
1International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
Heliyon
|December 3, 2024
概括
动态指数,如脉冲压力变化 (PPV) 和脉冲体积变化 (SVV),显示流体响应的适度预测值. 液体挑战后PPV或SVV的下降是可靠的,设备独立的液体响应性的标志物.
科学领域:
- 关键护理医学 关键护理医学
- 麻醉学 麻醉学
- 心血管生理学心血管生理学
背景情况:
- 流体响应 (FR) 的动态指数,如脉冲压变化 (PPV) 和脉冲体积变化 (SVV),用于指导流体治疗.
- 这些指数可能因专有算法而因血液动力学监测器而异,并且随着时间的推移而波动.
研究的目的:
- 为了比较PPV和SV的FR的基线值,波动和预测值.
- 评估PPV和SVV通过三种不同的微创血动力学监测器测量.
主要方法:
- 包括20名接受高风险腹部手术的患者.
- 同时使用Carescape B650,LiDCO Rapid和FloTrac/Vigileo系统进行监控.
- 分析了45个流体挑战,将流体响应者定义为挑战后心脏输出增加≥15%.
主要成果:
- 对于PPV和SVV的平均基线值在8.6%至13.4%之间.
- 与其他监控器相比,LiDCO的指数波动较高.
- 对于基线值的接收器运行特征曲线 (AUROC) 下的面积是中等的 (0.71-0.76).
- 液体挑战 (ΔPPV, ΔSVV) 后的PPV或SVV下降显示出更好的预测值 (AUROC 0.82-0.93),值约为-3%.
结论:
- 来自测试的监控器的基线PPV和SVV对FR具有中等和可比的预测值.
- ΔPPV 和 ΔSVV 是可靠且独立于设备的标记器,用于评估流体响应.
- 该研究强调了动态指数的实用性,特别是它们的变化后流体挑战,以指导血液动力学管理.
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