脉搏灌注变异指数监测肠道手术患者容量反应性的临床研究

目的 以经胸超声心动图监测左心室流出道血流的速度时间积分(VTI)为标准,评估脉搏灌注变异指数(PVI)预测肠道手术患者全身麻醉(以下简称全麻)诱导插管后容量反应性的能力.方法 选择全麻下拟行择期肠道手术的患者25例,在全麻诱导后,手术开始前输注7 mL/kg胶体液,若输液后VTI增加的百分比(△VTI％)≥10％,则用50 mL空针推注胶体液200 mL,直至△VTI％＜10％;分别记录每次输液前后平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、灌注指数(PI)、VTI、PVI等血流动力学指标.结果 对容量治疗有反应的患者PVI基础值明显高于对容量治疗无反应的患者(P＜0.05);Pearson相关性分析发现,补液前PVI的基础值与△VTI％呈明显线性相关(P＜0.05);PVI的最佳诊断阈值为13.51,其监测容量反应性的灵敏度为69.25％,特异度为70.00％;受试者工作特征曲线(ROC)下面积(AUC)为0.75(95％CI:0.63～0.88,P＜0.01).结论 PVI能够预测肠道手术患者的容量反应性,PVI值大于13.51提示患者可能处于低血容量状态,需要进行容量治疗.

Clinical study on pleth variability index for monitoring volume responsiveness in patients undergoing intestinal tract surgery

Objective To evaluate the ability of pleth variability index(PVI) for predicting volume responsiveness after general anesthesia induction intubation in the patients undergoing intestinal tract surgery with the velocity-time integral(VTI) of left ventricular outflow tract blood monitored by transthoracic echocardiography as the standard.Methods Twenty-five patients undergoing intestinal tract surgery were selected.After general anesthesia induction,7 mL/kg colloidal solution was infused before operation beginning,if the VTI increased percentage(△VTI％)≥10 ％,200 mL colloidal solution was infused by 50mL syringe until △VTI％＜10％;the hemodynamic indicators of MAP,CVP,HR,PI VTI and PVI were recorded before and after infusion solution.Results The PVI basic value in the patients with response was significantly higher than that in the patients without response(P＜0.05);the Pearson correlation analysis found that there was a significant linear correlation between PVI basic value and △VTI％ before infusion solution(P＜0.05);the optimal diagnostic threshold value of PVI was 13.51,its sensitivity for monitoring the volume responsiveness was 69.25％ and specificity was 70.00％.The area under the receiver operating characteristic(ROC) curve(AUC) was 0.75(95％ CI:0.63-0.88,P＜0.01).Conclusion PVI can predict the volume responsiveness in the patients undergoing intestinal tract surgery.The PVI value ＞13.51 indicates that the patient may be in hypovolemia status and needs the volume therapy.