摘要
目的评价梗阻性黄疸因素对左室舒张末容积(LVEDV)与每搏量变异度(SVV)监测容量反应性准确性的影响。方法择期行胰腺十二指肠切除术患者30例,性别不限,年龄45~60岁,体重55~70kg,ASA分级Ⅰ或Ⅱ级,心功能分级Ⅰ级。按血清总胆红素水平分为2组:A组(血清总胆红素≥17μmol/L,n=16)和B组(血清总胆红素<17μmol/L,n=14)。麻醉诱导后40min内输注6%羟乙基淀粉氯化钠注射液500ml,容量负荷前、后记录Vigileo^TM参数:每搏量(CO)、SVV、外周血管阻力(SVR)和肺毛细血管楔压(PCWP);记录三维经食道超声心动图测定指标:LVEDV、左室收缩末容积(LVESV)、CO′、左室射血分数(LVEF)及舒张早期二尖瓣环运动速度的比值(E/e′)。结果与容量负荷前比较,容量负荷后2组SVV降低、B组CO、LVEDV、CO′及LVEF增高,A组E/e′增高(P<0.05);与B组比较,A组容量负荷前、后CO、SVR、CO′及LVEF降低,PCWP增高(P<0.05)。结论梗阻性黄疸因素可降低LVEDV监测容量反应性的准确性,对SVV无影响。
Objective To evaluate the effect of obstructive jaundice on the accuracy of left ventricular end-diastolic volume (LVEDV) and stroke volume variability (SVV) in monitoring fluid responsiveness. Methods Thirty patients of both sexes, aged 45-60 yr, weighing 55-70 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with New York Heart Association Ⅰ, scheduled for elective pancreatoduodenectomy, were divided into 2 groups according to the serum total bilirubin levels: A group (serum total bilirubin≥17 μmmol/L, n=16) and B group (serum total bilirubin<17 μmmol/L, n=14). Six percent hydroxyethyl starch 500 ml was infused over 40 min after anesthesia induction.The parameters of Vigileo? such as cardiac output (CO), SVV, systemic vascular resistance (SVR) and pulmonary capillary wedge pressure and indices measured by transesophageal three-dimensional echocardiography such as LVEDV, left ventricular end-systolic volume, CO′, left ventricular ejection fraction (LVEF) and ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e′, E/e′ ratio) were recorded before and after fluid loading. Results Compared with that before fluid loading, SVV was significantly decreased in two groups, and CO, LVEDV, CO′ and LVEF were significantly increased in group B, and E/e′ ratio was significantly increased in group A (P<0.05). Compared with group B, CO, SVR, CO′ and LVEF were significantly decreased, and pulmonary capillary wedge pressure was increased in group A (P<0.05). Conclusion Obstructive jaundice causes decrease in the accuracy of LVEDV in monitoring fluid responsiveness and no effect on SVV.
作者
华玉芳
张双银
王小峰
白洁
张荣智
徐旭
Hua Yufang;Zhang Shuangyin;Wang Xiaofeng;Bai Jie;Zhang Rongzhi;Xu Xu(Department of Anesthesiology,Lanzhou University Second Hospital,Lanzhou 730030, China;Department of Ultrasound, Lanzhou University Second Hospital,Lanzhou 730030,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2018年第12期1490-1492,共3页
Chinese Journal of Anesthesiology
基金
甘肃省自然科学基金(1606RJZA115).
关键词
血管容量
黄疸
阻塞性
每搏输出量
超声心动描记术
经食管
Load volume
Stroke volume variability
Left ventricular end-systolic volume
Three-dimensional transesophageal echocardiography
Obstructive jaundice
