Stroke Volume Variation and Pulse Pressure Variation Are Not Useful for Predicting Fluid Responsiveness in Thoracic Surgery
Stroke Volume Variation and Pulse Pressure Variation Are Not Useful for Predicting Fluid Responsiveness in Thoracic Surgery
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每搏输出量变异和脉压变异对预测胸外科手术中的液体反应性并无帮助
DOI：
10.1213/ane.0000000000002056
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发表时间：
2017-10-01
影响因子：
5.7
通讯作者：
Park, Joohyun
中科院分区：
文献类型：
--
作者：
Jeong, Dae Myoung;Ahn, Hyun Joo;Park, Joohyun
背景技术背景：每搏输出量变异度（SW）和脉压变异度（PPV）被用作液体反应性的指标，但对这些动态前负荷指标在胸外科手术中的有用性知之甚少，胸外科手术涉及开放胸腔和单肺通气（OLV）。因此，我们调查了SW和PPV是否可以预测液体反应性，以及这些参数的阈值是否应该调整为胸外科手术。方法：这是一项前瞻性，对照研究在三级保健中心进行。纳入了80例计划接受需要OLV的择期肺叶切除术的患者（n = 40，电视辅助胸腔镜手术（VATS）; n = 40，开放性开胸术）。开胸后20分钟，给予7 mL/kg羟乙基淀粉30分钟。各种血流动力学参数测量之前和之后的液体challenge.Results：在本研究中招募的80例患者中，37%的液体反应（每搏输出量指数增加1.0%）。无应答者和应答者之间液体挑战前的SW无差异（平均SD：7.1 +/- 2.7% vs 7.4 +/-2.6%，P = 0.68）。无论手术是否涉及开胸术或VATS，这一发现都是正确的。液体激发前的PPV显示无应答者和应答者之间存在差异（平均值+/- SD：6.9 +/- 3.0% vs 8.4 +/- 3.2%; P = 0.045）;然而，阈值（PPV = 7%）的灵敏度和特异性较低（分别为58%和62%），接受者操作下的面积。特征曲线仅为0.63（95%置信区间，0.52-0.74; P = 0.041）。结论：动态前负荷指标对预测VATS或开胸手术中的液体反应性没有帮助。
BACKGROUND: Stroke volume variation (SW) and pulse pressure variation (PPV) are used as indicators of fluid responsiveness, but little is known about the usefulness of these dynamic preload indicators in thoracic surgery, which involves an open thoracic cavity and 1-lung ventilation (OLV). Therefore, we investigated whether SW and PPV could predict fluid responsiveness, and whether the thresholds of these parameters should be adjusted for thoracic surgery.METHODS: This was a prospective, controlled study conducted in a tertiary care center. Eighty patients scheduled for an elective lobectomy requiring OLV were included (n = 40, video-assisted thoracoscopic surgery (VATS); n = 40, open thoracotomy). Twenty minutes after opening the thoracic cavity, 7 mL/kg hydroxyethyl starch was administered for 30 minutes. Various hemodynamic parameters were measured before and after fluid challenge.RESULTS: Among the 80 patients enrolled in this study, 37% were fluid responders (increase in stroke volume index 1.0%). SW before fluid challenge was not different between nonresponders and responders (mean SD: 7.1 +/- 2.7% vs 7.4 +/- 2.6%, P = .68). This finding was true regardless of whether the surgery involved open thoracotomy or VATS. PPV before fluid challenge showed the difference between nonresponders and responders (mean +/- SD: 6.9 +/- 3.0% vs 8.4 +/- 3.2%; P = .045); however, the sensitivity and specificity of the threshold value (PPV = 7%) were low (58% and 62%, respectively) and the area under the receiver operating. characteristics curve was only 0.63 (95% confidence interval, 0.52-0.74; P = .041).CONCLUSIONS: Dynamic preload indicators are not useful for predicting fluid responsiveness in VATS or open thoracic surgery.