CAJ | 학술논문

目的评价每搏输出量变异度(SVV)监测非体外循环冠状动脉旁路移植术患者血容量变化的准确性.方法择期行非体外循环冠状动脉旁路移植术患者21例,性别不限,年龄44～77岁,体重43～93 kg,ASA分级Ⅱ或Ⅲ级.开胸打开心包,待血液动力学稳定5 min时(T1),以0.25ml·kg-1·min-1的速率静脉输注6％羟乙基淀粉130/0.4氯化钠注射液7 ml/kg.于T1和输注完毕后10min(T2)时记录HR、MAP、CVP、体循环血管阻力(SVR)、体循环血管阻力指数(SVRI)、SVV、每搏输出量指数(SVI)和CI,并计算变化率(△HR、△MAP、△CVP、△SVR、△SVV、△SVI和△CI).△HR、△MAP、△CVP、△SVR、△SVV与△SVI进行Pearson相关性分析.以△SVI≥25％为扩容有效的标准,绘制HR、MAP、CVP、SVR、SVV监测血容量变化的ROC曲线,计算曲线下面积及其95％可信区间.结果与T1时比较,T2时CVP、SVI、CO和CI升高,SVRI和SVV降低(P＜0.01),MAP和HR差异无统计学意义(P＞0.05).△HR、△SVR与△SVI均呈负相关,相关系数分别为-0.737和- 0.480(P＜ 0.05)；△CVP、△MAP、△SVV与△SVI无相关性(P＞0.05).ROC曲线分析结果显示:SVV的诊断阈值为8.8％,灵敏度为52.6％,特异度为100.0％.ROC曲线下面积及其95％可信区间为0.579(0.346 ～ 0.812).结论 SVV不能准确地监测非体外循环冠状动脉旁路移植术患者的血容量变化.
목적 평개매박수출량변이도(SVV)감측비체외순배관상동맥방로이식술환자혈용량변화적준학성.방법 택기행비체외순배관상동맥방로이식술환자21례,성별불한,년령44～77세,체중43～93 kg,ASA분급Ⅱ혹Ⅲ급.개흉타개심포,대혈액동역학은정5 min시(T1),이0.25ml·kg-1·min-1적속솔정맥수주6％간을기정분130/0.4록화납주사액7 ml/kg.우T1화수주완필후10min(T2)시기록HR、MAP、CVP、체순배혈관조력(SVR)、체순배혈관조력지수(SVRI)、SVV、매박수출량지수(SVI)화CI,병계산변화솔(△HR、△MAP、△CVP、△SVR、△SVV、△SVI화△CI).△HR、△MAP、△CVP、△SVR、△SVV여△SVI진행Pearson상관성분석.이△SVI≥25％위확용유효적표준,회제HR、MAP、CVP、SVR、SVV감측혈용량변화적ROC곡선,계산곡선하면적급기95％가신구간.결과 여T1시비교,T2시CVP、SVI、CO화CI승고,SVRI화SVV강저(P＜0.01),MAP화HR차이무통계학의의(P＞0.05).△HR、△SVR여△SVI균정부상관,상관계수분별위-0.737화- 0.480(P＜ 0.05)；△CVP、△MAP、△SVV여△SVI무상관성(P＞0.05).ROC곡선분석결과현시:SVV적진단역치위8.8％,령민도위52.6％,특이도위100.0％.ROC곡선하면적급기95％가신구간위0.579(0.346 ～ 0.812).결론 SVV불능준학지감측비체외순배관상동맥방로이식술환자적혈용량변화.
Objective To evalute the accuracy of stroke volume variation (SVV) in monitoring blood volume in patients undergoing off-pump coronary artery bypass grafting.Methods Twenty-one ASA Ⅱ or Ⅲ patients of both sexes aged 44-77 yr undergoing off-pump coronary artery bypass grafting were enrolled in this study.Anesthesia was induced with midazolam,etomidate,fentanyl,rocuronium and dolicaine and maintained with target-controlled infusion of propofol,infusion of remifentanil,intermittent iv injetion of atracurium and inhalation of sevoflurane.The patients were mechanically ventilated (VT 8 ml/kg,RR 12 bpm,I:E 1:2,PEEP 0,FiO2 80％ ).PEr CO2 was maintained at 35-44 mm Hg.Radial artery was cannulated and connected to FloTrac pressure transducer and Vigileo monitor.6％ hydroxyethyl starch 130/0.4 sodium chloride solution 7 ml/kg was infused at a rate of 0.25 ml· kg- 1 1· min- 1 at 5 min of haemodynamics stabilization after pericardiotomy (T1).HR,MAP,CVP,systemic vascular resistance (SVR),systemic vascular nesistance index (SVRI),SVV,stroke volume index (SVI)and CI were recorded at T1 and at 10 min after loading dose (T2).The change rate of HR(△HR),MAP(△MAP),CVP(△CVP),SVR(△SVR),SVV(△SVV),SVI(△SVI) and CI(△CI) were calculated.△SVI≥25％ was considered effective volume expansion.The ROC curves for HR,MAP,CVP,SVR and SVV in determining the volume expansion efficacy were plotted.The area under the curves and 95 ％ confidence interval were calculated.Results Compared with T1,CVP,SVI,CO and CI were significantly increased,SVRI and SVV decreased at T2 (P ＜ 0.01).There was no significant difference in MAP and HR between T1 and T2(P ＞0.05).△SVI was negatively correlated with △HR and △SVR ( r =- 0.737,r =- 0.480,P ＜ 0.05).△SVI was not correlated with △CVP,△MAP and( P ＞ 0.05).The change in SVI was determined by SVV 8.8％ (sensitivity =52.6％,specificity =100.0％ ).The area under the curve for SVV and 95％ confidence interval were 0.579(0.346-0.812).Conclusion SVV can not be used to accuratelymonitor the changes in blood volume in patients undergoing off-pump coronary artery bypass grafting.