特伦登堡的位置降低了预测流体响应的动态变量的值:一项前性观察研究
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
概括
特伦登堡定位显著降低了脉冲体积变化 (SVV) 和脉冲压变化 (PPV). 这些动态变量在定向流体治疗中使用,在不同的倾斜角度必须谨慎地解释.
科学领域:
- 麻醉学
- 危急护理医学
- 心血管生理学
背景情况:
- 目标导向流体治疗 (GDFT) 使用动态变量,如中风体积变化 (SVV) 和脉冲压力变化 (PPV) 来优化流体的输送.
- 传统的静态参数通常不准确.
- 特伦德伦堡定位对动态血液动力学变量的影响尚不清楚.
研究的目的:
- 研究Trendelenburg倾斜角度对SV,PPV和其他血液动力学参数的影响.
- 为了确定动态变量是否随着倾斜角度而变化.
- 在Trendelenburg定位过程中对GDFT变量进行解释.
主要方法:
- 一项观察性研究涉及接受选择性手术的患者.
- 血液动力学变量 (SVV,PPV,dP/ dt,Eadyn,CI) 记录在仰卧位置 (0°) 和Trendelenburg在5°,10°,15°和25°的位置.
- 进行统计分析以评估变化和相关性.
主要成果:
- 增加Trendelenburg倾斜角度显著降低了SVV和PPV.
- 在仰卧位置的SVV和PPV与所有倾斜角度的值有显著的相关性.
- 随着倾斜的增加,心脏指数 (CI) 和收缩率 (dP/ dT) 也显著下降.
结论:
- SVV和PPV对流体反应的预测值被Trendelenburg倾斜改变.
- 这些动态变量需要对GDFT的倾斜角度进行谨慎的解释.
- 临床流体管理决策应考虑到患者的位置.
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