不同潮气量下脉搏血氧饱和度变异指数评估患者容量状态的准确性
摘要
目的探讨不同潮气量对脉搏血氧饱和度变异指数(PVI)监测机械通气患者容量状态的影响。方法选择硬膜外阻滞复合全身麻醉下行妇科恶性肿瘤手术患者100例,年龄31~59岁,ASAⅠ或Ⅱ级,随机分为5组,每组20例。5组患者潮气量分别设定为:A组10 mL/kg,B组9 mL/kg,C组8 mL/kg,D组7 mL/kg组和E组6 mL/kg。记录5组患者硬膜外给药前(T0)、给药后5 min(T1)、10 min(T2)、15 min(T3)及快速扩容后(T4)的心率(HR)、收缩压(SBP)、舒张压(DBP)、中心静脉压(CVP)和PVI。结果 T1~T3时E组PVI明显低于A组(P<0.05);相关性分析结果显示,A、B、C、D组PVI与CVP呈负相关(r=-0.310,P=0.002;r=-0.318,P=0.001;r=-0.298,P=0.004;r=-0.255,P=0.010);E组PVI与CVP无相关性(r=-0.189,P=0.059)。结论机械通气潮气量≥7 mL/kg时,PVI能有效判断患者循环容量的变化;当机械通气潮气量减小到6 mL/kg时,PVI监测患者容量状态缺乏准确性。
引文
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[11]Reuter DA,Bayerlein J,Goepfert MS,et al.Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients[J].Intensive Care Med,2003,29(3):476-480.
[12]Desebbe O,Boucau C,Farhat F,et al.The ability of pleth variability index to predict the hemodynamic effects of positive end-expiratory pressure in mechanically ventilated patients under general anesthesia[J].Anesth Analg,2010,110(3):792-798.
[2]徐子锋,张建海,郑吉建.脉搏灌注变异指数监测血容量变化的有效性[J].临床麻醉学杂志,2013,29(12):1187-1189.
[3]Smeding L,Pltz FB,Lamberts RR,et al.Mechanical ventilation with high tidal volumes attenuates myocardial dysfunction by decreasing cardiac edema in a rat model of LPS-induced peritonitis[J].Respir Res,2012,13(1):23.
[4]Peck MD,Koppelman T.Low-tidal-volume ventilation as a strategy to reduce ventilator-associated injury in ALI and ARDS[J].J Burn Care Res,2009,30(1):172-175.
[5]Cherpanath TG,Smeding L,Hirsch A,et al.Low tidal volume ventilation ameliorates left ventricular dysfunction in mechanically ventilated rats following LPS-induced lung injury[J].BMC Anesthesiol,2015,15:140.
[6]Lee HC,Tsai YF,Tsai HI,et al.Pulse oximeter-derived pleth variability index is a reliable indicator of cardiac preload in patients undergoing liver transplantation[J].Transplant Proc,2016,48(4):1055-1058.
[7]陈宇,傅强,米卫东.俯卧位呼吸末正压对每搏量变异度、脉搏压变异度和脉搏灌注变异指数预测容量准确性及阈值的影响[J].中国医学科学院学报,2015,37(2):179-184.
[8]蔡勤芳,米卫东,袁维秀.脉搏灌注变异指数监测机体容量状况的临床研究[J].中华外科杂志,2010,48(21):1628-1632.
[9]Feldman JM,Sussman E,Singh D,et al.Is the pleth variability index a surrogate for pluse pressure variation in a pediatric population undergoing spine fusion?[J].Paediatr Anaesth,2012,22(3):250-255.
[10]Broch O,Bein B,Gruenewald M,et al.Accuracy of the pleth variability index to predict fluid responsiveness depends on the perfusion index[J].Acta Anaesthesiol Scand,2011,55(6):686-693.
[11]Reuter DA,Bayerlein J,Goepfert MS,et al.Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients[J].Intensive Care Med,2003,29(3):476-480.
[12]Desebbe O,Boucau C,Farhat F,et al.The ability of pleth variability index to predict the hemodynamic effects of positive end-expiratory pressure in mechanically ventilated patients under general anesthesia[J].Anesth Analg,2010,110(3):792-798.