CAJ | 학술논문

目的探讨低血容量状态下患者每搏量变异度(SVV)与血容量的相关性.方法择期骨科手术患者20例,年龄20 ～ 64岁,BMI 20 ～ 30 kg/m2,ASA分级Ⅰ或Ⅱ级.气管插管后,稳定5 min,记录HR、MAP、CVP、动脉压力波形监测的心排量(APCO)、SVV、全身血管阻力(SVR)和心脏指数(CI).以30 ～ 50 ml/min的速率从中心静脉取血,取血量为全身血容量的5％,待血液动力学稳定5 min后记录上述血液动力学指标；再次以上述方法采血并记录血液动力学指标；随后以50 ～ 70 ml/min的速率经右侧颈内静脉输注相当于全身血容量5％的6％羟乙基淀粉130/0.4,待血液动力学稳定5 min后记录血液动力学指标；再次以上述方法补液并记录血液动力学指标.血容量变化(各时点血容量与基础值的差值)与dSVV(各时点监测值与基础值的差值)行线性相关分析.结果每次血容量变化后SVV、APCO和CI与前一状态比较差异均有统计学意义(P＜0.05或0.01),每次血容量变化后HR、MAP、CVP和SVR与前一状态比较差异并非均有统计学意义；dSVV与血容量变化呈负相关(r=-0.875,P＜0.01).结论低容量状态下SVV与血容量的相关性较高,可准确反映血容量的变化,可用于指导低血量容状态下的容量治疗.
목적 탐토저혈용량상태하환자매박량변이도(SVV)여혈용량적상관성.방법 택기골과수술환자20례,년령20 ～ 64세,BMI 20 ～ 30 kg/m2,ASA분급Ⅰ혹Ⅱ급.기관삽관후,은정5 min,기록HR、MAP、CVP、동맥압력파형감측적심배량(APCO)、SVV、전신혈관조력(SVR)화심장지수(CI).이30 ～ 50 ml/min적속솔종중심정맥취혈,취혈량위전신혈용량적5％,대혈액동역학은정5 min후기록상술혈액동역학지표；재차이상술방법채혈병기록혈액동역학지표；수후이50 ～ 70 ml/min적속솔경우측경내정맥수주상당우전신혈용량5％적6％간을기정분130/0.4,대혈액동역학은정5 min후기록혈액동역학지표；재차이상술방법보액병기록혈액동역학지표.혈용량변화(각시점혈용량여기출치적차치)여dSVV(각시점감측치여기출치적차치)행선성상관분석.결과 매차혈용량변화후SVV、APCO화CI여전일상태비교차이균유통계학의의(P＜0.05혹0.01),매차혈용량변화후HR、MAP、CVP화SVR여전일상태비교차이병비균유통계학의의；dSVV여혈용량변화정부상관(r=-0.875,P＜0.01).결론 저용량상태하SVV여혈용량적상관성교고,가준학반영혈용량적변화,가용우지도저혈량용상태하적용량치료.
Objective To investigate the correlation between stroke volume variation (SVV) and blood volume during hypovolemia.Methods Twenty ASA Ⅰ or Ⅱ patients,aged 20-64 yr,with body mass index 20-30 kg/m2,scheduled for elective orthopedic operation,were studied.Anesthesia was induced with dexamethasone,midazolam,propofol,fentanyl and cisatracurium and maintained with sevoflurane,fentanyl and cisatracurium.The patients were tracheal intubated and mechanically ventilated.HR,MAP,CVP,arterial pressure-based cardiac output (APCO),SVV,systemic vascular resistance (SVR) and cardiac index (CI) were recorded 5 min after tracheal intubation.Blood was taken from central vein at a rate of 30-50 ml/min,the volume was 5％ of the whole blood volume and the haemodynamic parameters mentioned above were recorded after the haemodynamics was kept stable for 5 min.Blood was taken again as the method mentioned above and the haemodynamic parameters were recorded.6％ HES 130/0.4 was then infused at 50-70 ml/min via right internal jugular vein,the volume was equal to 5 ％ of the whole blood volume and the haemodynamic parameters were recorded after the haemodynamics was kept stable for 5 min.Fluid replacement was performed again using the method mentioned above and the haemodynamic parameters were recorded.Linear correlation of the change in blood volume (difference between the blood volume at each time point and the baseline value) with dSVV (difference between the value monitored at each time point and the baseline value) was analyzed.Results There was significant change in SVV,APCO and CI after each change in blood volume ( P ＜ 0.05 or 0.01),while there was not always significant change in HR,MAP,CVP and SVR after each change in blood volume.The change in blood volume was negatively correlated with dSVV ( r =- 0.875,P ＜ 0.01 ).Conclusion There is high correlation between SVV and blood volume during hypovolemia and SVV can reflect the change in blood volume accurately and be used for volume therapy during hypovolemia.