摘要
目的探讨LiDCOrapid无创模式在老年患者腹部手术中应用的准确性及可行性。方法选择2015年6~12月解放军总医院择期行腹部手术的老年患者(>65岁)20例,中青年患者20例。静脉麻醉诱导,气管内插管,机械通气后进行容量反应试验,分别记录液体冲击前后Philip IntelliVue MP50、Flotrac/Vigileo及LiDCOrapid仪器上HR、MAP、中心静脉压(central venous pressure, CVP)、心输出量(cardiac output, CO)、每搏量(stroke volume, SV)、每搏变异度(stroke volumevariation, SVV)、脉压变异度(pulse pressure variation, PPV)等血流动力学参数,输液后每搏量指数(stroke volume index,SVI)变化增加≥10%为阳性组,计算各参数ROC曲线的AUC及阈值,并进行有创与无创监测结果的相关性及一致性分析。结果经LiDCOrapid测得老年患者PPV、SVV诊断阈值分别为8.5%,9.5%,ROC曲线的AUC分别均为0.719,低于中青年患者(0.798、0.803)。老年患者与中青年患者经LiDCOrapid测得PPV、SVV的ROC曲线的AUC均小于Flotrac/Vigil?eo。LiDCOrapid与Flotrac/Vigileo冲击试验前后MAP、CO、SV、PPV、SVV的95%一致性界限百分比分别为95.0%、96.5%、95.0%、92.5%、95.0%,相关系数分别为0.769、0.825、0.759、0.620、0.527。结论 LiDCOrapid无创模式监测的PPV、SVV可以用于预测老年患者容量反应,虽与有创方法获得的数据相比,LiDCOrapid的准确性下降,但两种仪器监测的数据具有较好的一致性。
Objective To evaluate the accuracy and feasibility of the continuous noninvasive hemodynamic monitoring(LiDCOrapid)in the application of abdominal surgery in elderly patients.Methods Forty patients undergoing selective abdominal surgery were enrolled.They were divided into 2 groups:the elderly group(age>65,n=20)and the young and middleaged group(n=20).After the induction anesthesia,the volume expansion therapy was performed.The hemodynamic parameters including mean arterial pressure(MAP),central venous pressure(CVP),cardiac output(CO),stroke volume(SV),stroke volume variation(SVV),pulse pressure variation(PPV)were recorded by the Philip IntelliVue MP50,Flotrac/Vigileo and LiDCOrapid monitor simultaneously.Fluid positive responsiveness was defined as stroke volume index(SVI)≥10%.The receiver operation characteristic(ROC)curves were used to assess the ability of each parameter to predict the fluid responsiveness both in the elderly group and the young and middle-aged group.Statistical analysis was performed to assess the agreement and correlation between the 2 monitor methods.Results The PPV and SVV thresholds valued by LiDCOrapid among elderly people were 8.5%and 9.5%,respectively.AUC of SVV and PPV were 0.719 equally,which were less than those of the young and middle age group(0.798,0.803).AUC of SVV,PPV measured by LiDCOrapid were less than Flotrac/Vigileo among the whole patients.The correlation of MAP,CO,SV,PPV,SVV were 0.769,0.825,0.759,0.620,0.527.Conclusions PPV,SVV measured by LiDCOrapid are able to predict the fluid responsiveness.Compared with the parameters obtained by the invasive method,the accuracy of LiDCOrapid decreases,but the consistency of the two monitor methods is good.
作者
张璇
李皓
马冀
刘季东
米卫东
Zhang Xuan;Li Hao;Ma Ji;Liu Jidong;Mi Weidong(Department of Anesthesiology,Chinese PLA General Hospital,Beijing 200853,China)
出处
《北京医学》
CAS
2019年第1期10-14,共5页
Beijing Medical Journal
关键词
无创血流动力学监测
老年患者
容量反应
noninvasive hemodynamic monitoring
elderly patients
fluid responsiveness
