CAJ | 학술논문

目的评价每搏量变异度(SVV)监测腹腔镜手术患者血容量变化的准确性.方法择期行腹腔镜手术患者40例,性别不限,年龄40 ～ 64岁,体重指数20～ 25 kg/m2,ASA分级Ⅰ或Ⅱ级.全麻后建立气腹,行容量负荷试验:静脉输注6％羟乙基淀粉130/0.4氯化钠注射液500 ml,输注时间30 min.于气腹前(T1)、气腹后3 min(T2)、容量负荷前即刻(T3)、容量负荷后3 min(T4)时记录心输出量(CO)、心脏指数(CI)、每搏量(SV)、每搏量指数(SVI)和SVV.以△CI≥15％为容量负荷试验阳性标准,绘制SVV判断容量变化的ROC曲线,计算曲线下面积及95％可信区间.结果与T1时比较,T2时SVV降低(P＜0.05);与T3时比较,T4时CO、CI、SV、SVI升高,SVV降低(P＜0.05).ROC曲线分析结果示:SVV监测血容量变化的阈值为9.2％时,灵敏度为61％,特异度为50％,曲线下面积(95％可信区间)为0.567(0.378～0.757).结论 SVV不适于作为监测腹腔镜手术患者血容量变化的指标.
목적 평개매박량변이도(SVV)감측복강경수술환자혈용량변화적준학성.방법 택기행복강경수술환자40례,성별불한,년령40 ～ 64세,체중지수20～ 25 kg/m2,ASA분급Ⅰ혹Ⅱ급.전마후건립기복,행용량부하시험:정맥수주6％간을기정분130/0.4록화납주사액500 ml,수주시간30 min.우기복전(T1)、기복후3 min(T2)、용량부하전즉각(T3)、용량부하후3 min(T4)시기록심수출량(CO)、심장지수(CI)、매박량(SV)、매박량지수(SVI)화SVV.이△CI≥15％위용량부하시험양성표준,회제SVV판단용량변화적ROC곡선,계산곡선하면적급95％가신구간.결과 여T1시비교,T2시SVV강저(P＜0.05);여T3시비교,T4시CO、CI、SV、SVI승고,SVV강저(P＜0.05).ROC곡선분석결과시:SVV감측혈용량변화적역치위9.2％시,령민도위61％,특이도위50％,곡선하면적(95％가신구간)위0.567(0.378～0.757).결론 SVV불괄우작위감측복강경수술환자혈용량변화적지표.
Objective To evaluate the accuracy of stroke volume variation (SVV) in monitoring the changes in blood volume during laparoscopic surgery.Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 40-64 yr,with body mass index ranged from 20 to 25 kg/m2,scheduled for elective laparoscopic surgery under general anesthesia,were studied.After induction of general anesthesia,baseline registrations of variables were obtained.After establishing pneumoperitoneum,6％ hydroxyethyl starch (HES 130/0.4) 500 ml was infused over 30 min.Before pneumoperitoneum (T1),at 5 min after pneumoperitoneum (T2),immediately before volume expansion (T3) and at 3 min after volume expansion (T4),cardiac output (CO),cardiac index (CI),SV,stroke volume index (SVI) and SVV were monitored and recorded.The changing rate of CI (△CI) was calculated.The criterion for effective volume expansion was △CI ≥ 15％.The ROC curve for SVV in determining the volume expansion responsiveness was plotted,and the diagnostic threshold was determined.The area under the curve and 95％ confidence interval were calculated.Results SVV was significantly lower at T2 than at T1.CO,CI,SV and SVI were significantly higher,and SVV was lower at T4 than at T3.The results of ROC curve analysis showed that a 9.2％ SVV threshold discriminated between responders and non-responders with a sensitivity of 61％ and a specificity of 50％,and the area under the curve (95％ confidence interval) was 0.567 (0.378-0.757).Conclusion SVV is not a suitable index in monitoring the changes in blood volume during laparoscopic surgery.