颈动脉峰值流速变异率对择期行腹腔镜下手术老年病人容量反应性的评估价值

吴超贤; 张莉

doi:10.13898/j.cnki.issn.1000-2200.2022.04.018

颈动脉峰值流速变异率对择期行腹腔镜下手术老年病人容量反应性的评估价值

吴超贤,
张莉

Value of the variation rate of carotid peak flow in the evaluation of volumetric responsiveness in elderly patients scheduled by laparoscopic surgery

摘要

摘要:
目的探讨颈动脉峰值流速变异率对择期行腹腔镜下手术老年病人容量反应性的评估价值。
方法选取63例择期行腹腔镜下手术老年病人，根据病人液体阳性反应情况，将心脏指数增加量≥15%作为反应组(n=38)，心脏指数增加量 < 15%作为非反应组(n=25)。分析2组在麻醉诱导5 min、气腹压稳定5 min及补液5 min的心率、平均动脉压、每搏量变异度、中心静脉压、颈动脉峰值流速变异率、气道峰压及心脏指数变化；分析气腹压稳定5 min的颈动脉峰值流速变异率、每搏量变异度、中心静脉压与心脏指数的关系，并绘制受试者工作特征曲线，判断指标对液体阳性反应的预测效能。
结果反应组各时间节点的心率及心脏指数均低于非反应组(P < 0.05~P < 0.01)；反应组各时间节点的每搏量变异度、颈动脉峰值流速变异率均高于非反应组(P < 0.01)；气腹压稳定5 min的颈动脉峰值流速变异率、每搏量变异度与心脏指数呈负相关关系(r=-0.638、r=-0.517，P < 0.05)；气腹压稳定5 min的颈动脉峰值流速变异率的灵敏度为86.96%，特异度为87.50%，曲线下面积为0.877(0.758~0.958)；经Delong检验发现，气腹压稳定5min的颈动脉峰值流速变异率预测效能高于每搏量变异度及中心静脉压，差异有统计学意义(P < 0.05)。
结论颈动脉峰值流速变异率可有效评估择期行腹腔镜下手术老年病人容量反应性。

Abstract:
ObjectiveTo explore the value of the variation rate of carotid peak flow in the evaluation of volumetric responsiveness in elderly patients scheduled by laparoscopic surgery.
MethodsSixty-three elderly patients scheduled by laparoscopic surgery were investigated.According to the positive liquid reaction, the patients with the increase of cardiac index ≥15% was set as the reaction group(n=38), and the patients with increase of cardiac index < 15% was set as the non-reaction group(n=25).The changes of heart rate, mean arterial pressure, stroke volume variability, central venous pressure, peak velocity variability of carotid artery, peak airway pressure and heart index in two groups were analyzed at anesthesia induction 5 min, pneumoperitoneum pressure stabilization 5 min and fluid replacement 5 min.The relationship between the variation rate of carotid peak flow at pneumoperitoneum pressure stabilization 5 min, stroke volume variation, central venous pressure and cardiac index were analyzed, the receiver operating characteristic(ROC) curve of subjects was drawn, and the predictive efficacy of the index for liquid positive reaction was judged.
ResultsThe heart rate and heart index in reaction group were lower than those in non-reaction group(P < 0.05 to P < 0.01).The variation of stroke volume and peak velocity of carotid artery in reaction group were higher than those in non-reaction group(P < 0.01).The variation rate of peak velocity of carotid artery at pneumoperitoneum pressure stabilization 5 min and stroke volume variability were negatively correlated with heart index(r=-0.638, -0.517, P < 0.05).The sensitivity, specificity and area under the curve of carotid peak velocity variability at pneumoperitoneum pressure stabilization 5 min were 86.96%, 87.50% and 0.877(0.758-0.958), respectively.The results of Delong test showed that the predictive efficacy of the variability rate of peak velocity of carotid artery at pneumoperitoneum pressure stabilization 5 min was higher than that of the variability of stroke volume and central venous pressure(P < 0.05).
ConclusionsThe variability of peak velocity of carotid artery can effectively evaluate the volumetric responsiveness of elderly patients scheduled by laparoscopic surgery.

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