CAJ | 학술논문

目的研究中心静脉血氧饱和度变化(ΔScvO2)预测心脏术后机械通气患者容量反应性的价值.方法对心脏术后患者29例进行容量负荷试验.通过FloTrac/Vigileo系统监测心排量(CO)、外周血管阻力指数(SVRI)、每博量变异(SVV)等血流动力学指标.通过中心静脉导管抽血测量中心静脉血氧饱和度(ScvO2).根据容量负荷前后心排量增加值(ΔCO)是否>12%分为有反应组和无反应组.通过直线相关回归分析ΔScvO2与ΔCO关系.绘制ROC曲线评价ΔScvO2、中心静脉压变化(ΔCVP)、动脉压变化(ΔMAP)、容量负荷前SVV预测容量反应性的价值.结果容量负荷后ΔScvO2与ΔCO存在直线相关(r=0.670,P=0.000).容量负荷后ΔScvO2、ΔCVP、ΔMAP预测容量反应性曲线下面积分别是0.900(95%CI0.777~1,P=0.000)、0.450(95%CI0.235~0.665, P=0.647)、0.657(95%CI0.455~0.859,P=0.150);SVV曲线下面积0.833(95%CI0.684~0.982,P=0.002).以ΔScvO2取4%作为切点来预测容量反应性,其敏感度92.9%,特异度86.7%.结论ΔScvO2可以作为预测心脏术后患者容量反应性的可靠指标,而且明显优于CVP、MAP等传统指标.
목적연구중심정맥혈양포화도변화(ΔScvO2)예측심장술후궤계통기환자용량반응성적개치.방법대심장술후환자29례진행용량부하시험.통과FloTrac/Vigileo계통감측심배량(CO)、외주혈관조력지수(SVRI)、매박량변이(SVV)등혈류동역학지표.통과중심정맥도관추혈측량중심정맥혈양포화도(ScvO2).근거용량부하전후심배량증가치(ΔCO)시부>12%분위유반응조화무반응조.통과직선상관회귀분석ΔScvO2여ΔCO관계.회제ROC곡선평개ΔScvO2、중심정맥압변화(ΔCVP)、동맥압변화(ΔMAP)、용량부하전SVV예측용량반응성적개치.결과용량부하후ΔScvO2여ΔCO존재직선상관(r=0.670,P=0.000).용량부하후ΔScvO2、ΔCVP、ΔMAP예측용량반응성곡선하면적분별시0.900(95%CI0.777~1,P=0.000)、0.450(95%CI0.235~0.665, P=0.647)、0.657(95%CI0.455~0.859,P=0.150);SVV곡선하면적0.833(95%CI0.684~0.982,P=0.002).이ΔScvO2취4%작위절점래예측용량반응성,기민감도92.9%,특이도86.7%.결론ΔScvO2가이작위예측심장술후환자용량반응성적가고지표,이차명현우우CVP、MAP등전통지표.
Objective To assess changes of central venous oxygen saturation (ΔScvO2)in predicting volume respon-siveness of mechanically ventilated patients after cardiac surgery. Methods A total of 29 mechanical y ventilated patients after cardiac surgery were admitted from June 2010 to May 2011. Patients were treated with volume expansion (VE). Cardiac output (CO), systemic vascular resistance index (SVRI) and stroke volume variation (SVV) were measured with Vigileo/FloTrac system. ScvO2 was measured before and after volume load through central venous catheter. Responders (R) were defined as patients who increased their CO (ΔCO)≥12%after VE, and nonresponders (NR) as patients withΔCO<12%after VE. ScvO2 and CO changes after VE were analyzed using linear correlation and regression. The role ofΔScvO2 , central venous pressure changes (ΔCVP), mean arterial pressure change (ΔMAP) and SVV before VE were evaluated by receiver operating characteristic(ROC) curves. Results ΔScvO2 was significantly correlated with ΔCO after VE (r=0.670, P=0.000). The areas under ROC curves (AUC) were 0.900(95%CI:0.777~1, P=0.000), 0.450(95%CI:0.235~0.665, P=0.647), 0.657(95%CI:0.455~0.859, P=0.150) and 0.833 (95%CI:0.684~0.982, P=0.002)for ΔScvO2,ΔCVP,ΔMAP and SVV,respectively. ΔScvO2 threshold value of 4%allowed the definition of R and NR patients with 92.9%sensitivity and 86.7%specificity. Conclusion ΔScvO2 can serve as valid indicator of predicting volume responsiveness in mechanical y ventilated patients after cardiac surgery,and it is more realibale than conventional indicators such as CVP or MAP.