潮体积挑战诱导的血液动力学变化对流体响应的预测价值,在接受胸腔镜手术的患者中使用单肺通风:一项前性观察研究
Yong Zhan1, Qi-Quan Zhang1, Xiao-Qiang Wang1
1Department of Anesthesiology, Fuyang Affiliated Hospital of Anhui Medical University, Fuyang, 236000, China.
BMC anesthesiology
|March 7, 2026
概括
潮体积挑战有效地预测了在VATS期间接受单肺通风的患者的流体反应. 脉冲体积变化和脉冲压力变化的变化准确地表明流体需求,无论患者的位置如何.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 胸部外科手术 胸部外科手术
背景情况:
- 视频辅助胸部手术 (VATS) 需要单肺通风 (OLV),这复杂化了液体反应能力的评估.
- 在OLV中使用的肺保护通风策略限制了传统动态参数的可靠性.
- 潮体积挑战 (TVC) 是一种潜在的方法来评估OLV期间的流体响应能力.
研究的目的:
- 为了评估TVC诱导的动脉冲量变化 (ΔSVV_TVC) 和脉冲压变化 (ΔPPV_TVC) 的变化对预测流体响应性的有效性.
- 评估患者的位置是否会影响OLV期间 ΔSVV_TVC 和 ΔPPV_TVC 的预测性能.
主要方法:
- 研究了60名与OLV一起接受VATS的患者.
- 血液动力学参数,包括SVV和PPV,在TVC (增加潮体积从6到8毫升/公斤) 之前和之后记录.
- 流体响应性是通过在体积负荷测试后,中风体积指数增加10%来确定的.
主要成果:
- 在43%的患者 (26/60) 中观察到流体反应.
- ΔSVV_TVC显示AUC为0.83 (截止值>2%),而 ΔPPV_TVC显示AUC为0.86 (截止值>3%),用于预测流体响应.
- 在左侧和右侧位之间没有发现预测性能的显著差异.
结论:
- 在SVV和PPV中TVC诱导的变化是OLV患者流体反应的可靠预测因素.
- 患者的位置不会影响这些动态参数在预测OLV期间的流体反应的准确性.
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