肺叶切除术患者不同通气模式下每搏量变异度的变化

目的 探讨肺叶切除术患者不同通气模式下每搏量变异度(SW)的变化.方法 择期行肺叶切除术患者44例,年龄44～64岁,体重47～86 kg,ASA分级Ⅰ或Ⅱ级.采用FloTrac压力换能器及Vigileo心输出量监测仪持续监测CI、每搏量指数(SVI)和SVV.术中补液速率6～8 ml·kg-1·h-1(晶胶比1∶1)维持血容量.于仰卧位双肺通气5 min(T1)、侧卧位双肺通气2 min(T2)、单肺通气开胸前(T3)、单肺通气开胸后5 min(T4)、30 min(T5)、单肺通气+PEEP5 cm H2O 1 min(T6)、15 min(T7)、肺复张前(T8)、肺复张即刻(T9)和肺复张后1 min(T10)时记录SVV、CI和SVI.SVV＜ 13％为正常值.结果 患者术中血液动力学平稳,CI和SⅥ均在正常范围内波动.T9时SVV＞13％,其余各时间点均＜13％.SVV T2,3之间差异无统计学意义,T5～7之间差异均无统计学意义(P＞0.05)；T9时SVV较T8.10时升高(P＜0.01).结论 肺叶切除术中,单肺通气以及单肺通气联合PEEP 5 cm H2O时SVV可用于指导液体治疗的判断,而在肺复张时SVV不能指导液体治疗.

Changes in stroke volume variation monitored by FloTrac/Vigileo system during mechanical ventilation in patients undergoing pulmonary lobectomy

Objective To investigate the changes in stroke volume variation (SVV) monitored by FloTrac/Vigileo system during mechanical ventilation in patients undergoing pulmonary lobectomy.Methods Forty-four ASA Ⅰ or Ⅱ patients aged 44-64 yr weighing 47-86 kg undergoing elective pulmonary lobectomy performed under general anesthesia were studied.Blood volume was maintained by fluid (crystalloid∶ colloid 1∶1) infusion at a rate of 6-8 ml·kg-1 ·h-1.Cardiac output index (CI),stroke volume index (SVI) and SVV were measured based on arterial pressure wave form analysis by FloTrac/Vigileo System (Edwards Co.,USA) and recorded at following time points:at 5 min of two-lung ventilation (TLV) in supine position,2 min TLV in lateral position,during one-lung ventilation (OLV) before thoracotomy,at 5 and 30 min of OLV after thoracotomy,1 and 15 min OLV + PEEP of 5cm H2 O,before and immediately and 1 min after reflation of the remaining lobes.The normal value for SVV is less than 13％.Results The hemodynamic parameters were stable during lobectomy.CI and SVI were within normal range.SVV was less than 13％ at all time points except that at immediately after reflation of the remaining lobes.Conclusion SVV obtained with FloTrac/Vigileo system can be used to guide fluid therapy during OLV in mechanically ventilated patients undergoing pulmonary lobectomy.