Prediction of fluid responsiveness in patients during cardiac surgery
Prediction of fluid responsiveness in patients during cardiac surgery
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DOI：
10.1093/bja/aeh280
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发表时间：
2004-12-01
影响因子：
9.8
通讯作者：
Buhre, W
中科院分区：
文献类型：
--
作者：
Rex, S;Brose, S;Buhre, W
背景。左心室每搏输出量变异（SVV）已被证明是不同患者亚群液体反应性的预测因子。然而，SVV 的准确性和可靠性在低潮气量通气的患者中尚未得到证实。方法。 14 名患者在冠状动脉旁路移植术 (CABG) 后立即接受研究。所有患者均采用压力控制模式机械通气[潮气量7.5(1.2)ml kg(-1)]。除了标准血流动力学监测外，还通过动脉脉搏轮廓分析评估 SVV。左心室舒张末期面积指数（LVEDAI）通过经食管超声心动图测定。使用经肺热稀释技术测量心脏指数（CI）、每搏输出量指数（SVI）和胸腔内血容量指数（ITBI）。所有变量均在通过将患者从反特伦德伦堡位（头部向上 30 度）倾斜至特伦德伦堡位（头向下 30 度）引起的体积变化之前和之后进行评估。结果。特伦德伦伯卧位改变后，SVV显着下降，而CI、SVI、ITBI、LVEDAI、中心静脉压（CVP）和肺动脉闭塞压（PAOP）显着升高。 SVI 的变化与 SVV 的变化显着相关（r=0.70；P
Background. Left ventricular stroke volume variation (SVV) has been shown to be a predictor of fluid responsiveness in various subsets of patients. However, the accuracy and reliability of SVV are unproven in patients ventilated with low tidal volumes.Methods. Fourteen patients were studied immediately after coronary artery bypass grafting (CABG). All patients were mechanically ventilated in pressure-controlled mode [tidal volume 7.5 (1.2) ml kg(-1)]. In addition to standard haemodynamic monitoring, SVV was assessed by arterial pulse contour analysis. Left ventricular end-diastolic area index (LVEDAI) was determined by transoesophageal echocardiography. A transpulmonary thermodilution technique was used for measurement of cardiac index (CI), stroke volume index (SVI) and intrathoracic blood volume index (ITBI). All variables were assessed before and after a volume shift induced by tilting the patients from the anti-Trendelenburg (30degrees head up) to the Trendelenburg position (30degrees head down).Results. After the change in the Trendelenburg position, SVV decreased significantly, while CI, SVI, ITBI, LVEDAI, central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) increased significantly. Changes in SVI were significantly correlated to changes in SVV (r=0.70; P