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

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.