Evaluation of stroke volume variation and pulse pressure variation as predictors of fluid responsiveness in patients undergoing protective one-lung ventilation
Evaluation of stroke volume variation and pulse pressure variation as predictors of fluid responsiveness in patients undergoing protective one-lung ventilation
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DOI：
10.5582/ddt.2015.01046
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发表时间：
2015-08-01
影响因子：
3.1
通讯作者：
Mi, Weidong
中科院分区：
文献类型：
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作者：
Fu, Qiang;Duan, Mingda;Mi, Weidong
为了探讨血流动力学指标，包括每搏输出量变异度（SVV）和脉压变异度（PPV）是否可以预测保护性单肺通气患者的液体反应性。入选了60例计划接受胸腔镜和腹腔镜联合食管切除术的患者，并随机分为两组。保护组（P组）采用潮气量6 mL/kg，吸入氧分数（FiO（2））80%，呼气末正压（PEEP）5 cm H2O。常规组（C组）采用潮气量8 mL/kg、FiO 2 100%通气。在液体负荷（7 mL/kg羟乙基淀粉6%，0.4 mL/kg/min）之前和之后收集动态变量。每搏输出量指数（SVI）增加超过15%的患者被定义为应答者。最后分析了45例患者的数据。P组24例患者中的12例和C组21例患者中的10例为应答者。SVV和PPV在液体负荷后显著改变。受试者工作特征（ROC）分析显示，P组中SVV和PPV区分应答者的阈值分别为8.5%，敏感性分别为66.7%（SVV）和75%（PPV），特异性分别为50%（SVV）和83.3%（PPV）。C组SVV和PPV的阈值分别为8.5%和7.5%，敏感性分别为80%和90%，特异性分别为70%和80%。我们发现SVV和PPV可以预测保护性单肺通气中的液体反应性，但与常规通气策略相比，SVV和PPV的准确性和能力较弱。
In order to investigate whether the hemodynamic indices, including stroke volume variation (SVV) and pulse pressure variation (PPV) could predict fluid responsiveness in patients undergoing protective one-lung ventilation. 60 patients scheduled for a combined thoracoscopic and laparoscopic esophagectomy were enrolled and randomized into two groups. The patients in the protective group (Group P) were ventilated with a tidal volume of 6 mL/kg, an inspired oxygen fraction (FiO(2)) of 80%, and a positive end expiratory pressure (PEEP) of 5 cm H2O. Patients in the conventional group (Group C) were ventilated with a tidal volume of 8 mL/kg and a FiO(2) of 100%. Dynamic variables were collected before and after fluid loading (7 mL/kg hydroxyethyl starch 6%, 0.4 mL/kg/min). Patients whose stroke volume index (SVI) increased by more than 15% were defined as responders. Data collected from 45 patients were finally analyzed. Twelve of 24 patients in Group P and 10 of 21 patients in Group C were responders. SVV and PPV significantly changed after the fluid loading. The receive operating characteristic (ROC) analysis showed that the thresholds for SVV and PPV to discriminate responders were 8.5% for each, with a sensitivity of 66.7% (SVV) and 75% (PPV) and a specificity of 50% (SVV) and 83.3% (PPV) in Group P. However, the thresholds for SVV and PPV were 8.5% and 7.5% with a sensitivity of 80% (SVV) and 90% (PPV) and a specificity of 70% (SVV) and 80% (PPV) in Group C. We found SVV and PPV could predict fluid responsiveness in protective one-lung ventilation, but the accuracy and ability of SVV and PPV were weak compared with the role they played in a conventional ventilation strategy.