脉搏灌注变异指数监测小潮气量间歇正压通气患者容量状态的可行性研究

Feasibility of pleth variability index monitoring fluid responsiveness under low tidal volume intermittent positive pressure ventilation

摘要:

目的  探讨脉搏灌注变异指数（PVI）在小潮气量间歇正压通气（IPPV）时监测容量状态的可行性。方法  选择美国麻醉医师协会体格情况分级（ASA）Ⅰ、Ⅱ级的妇科恶性肿瘤手术患者60例，年龄32～59岁，随机分为A、B、C 3组，IPPV潮气量分别为10、8和6 ml/kg，每组20例。记录3组患者全身麻醉诱导后、硬膜外给药给前、给药后5、10和15 min及快速扩容后的心率（HR）、收缩压（SBP）、舒张压（DBP）、中心静脉压（CVP）和脉搏灌注变异指数（PVI）。结果  3组患者年龄、身高、体重和体重指数（BMI）比较，差异无统计学意义（P >0.05）；C组硬膜外给药后5、10和15 min PVI低于A组，差异有统计学意义（P <0.05）；A、B两组PVI与CVP呈负相关（r =-0.313和-0.295，P =0.002和0.004），C组的PVI与CVP无关（r =-0.191，P =0.057）。结论  PVI能有效判断8 ml/kg潮气量IPPV时循环容量的变化，当IPPV的潮气量过小时（6 ml/kg），PVI监测容量状态缺乏准确性。

Abstract:

Objective To research the feasibility of the pleth variability index (PVI) monitoring fluid responsiveness under low tidal volume intermittent positive pressure ventilation (IPPV). Methods Sixity ASAⅠ and Ⅱ female patients aged 32-59 years and scheduled for elective gynecological malignancy surgery, were randomly divided into groups A (10 ml/kg), B (8 ml/kg) and C (6 ml/kg) according to tidal volume. HR, SBP, DBP, CVP and PVI were continuously monitored after induction of general anesthesia. The data monitored above were recorded before intraspinal administration, at 5, 10 and 15 min after intraspinal administration, and after rapid transfusion. Results There were no significant differences in age, body height, weight and body mass index (BMI) (P > 0.05) among the 3 groups. PVI of the group C was lower than that of the group A at 5, 10 and 15 min after intraspinal administration (P < 0.05). PVI was negatively associated with CVP in the group A (r = -0.313, P = 0.002) and group B (r = -0.295, P = 0.004). There was no correlation between PVI and CVP in the group C (r = -0.191, P = 0.057). Conclusions PVI can effectively monitor fluid responsiveness under 8 ml/kg tidal volume IPPV, but when the tidal volume is 6 ml/kg PVI monitoring fluid responsiveness will be lack of accuracy.