国际麻醉学与复苏杂志   2020, Issue (1): 0-0
    
颈内静脉呼吸变异度在评估腹腔镜手术患者容量反应性中的作用
彭艺, 张扬, 高巨, 王骁颖, 方向志, 王存金1()
1.江苏省苏北人民医院麻醉科
Application of variation of internal jugular vein respiration for predicting fluid responsiveness in patients undergoing laparoscopic surgery
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摘要：

目的 评价颈内静脉呼吸变异度（variation of internal jugular vein respiration, VIJVR）在评估腹腔镜手术患者容量反应性中的作用。 方法 选择2016年11月至2017年3月我院择期行腹腔镜结肠癌根治术的患者44例，年龄40~65岁，BMI 18~25 kg/㎡，ASA分级Ⅰ、Ⅱ级。患者入室后监测ECG、心率、SpO2和无创血压（noninvasive blood pressure, NIBP）、CVP、心排血量（cardiac output, CO）、心排血指数（cardiac index, CI）、每搏量变异度（stroke volume variation, SVV）、每搏量指数（stroke volume index, SVI）等参数。应用超声测量并记录3个呼吸周期内颈内静脉吸气相最大直径 （the maximum of the diameter of internal jugular vein, DIJVmax）和呼气相最小直径（the minimum of the diameter of internal jugular vein, DIJVmin），以公式VIJVR=［（DIJVmax−DIJVmin）/DIJVmin］×100%计算VIJVR。在腹腔镜手术开始后10 min时于15 min内快速输注6%羟乙基淀粉130/0.4（hydroxyethyl starch, HES130/0.4, 500 ml）氯化钠注射液7 ml/kg，记录气管插管后10 min（T1）、气腹开始后10 min（T2）、6％HES130/0.4输注完毕10 min后（T3）的心率、血压、CO、CI、SVV、SVI、VIJVR等指标，依据补液后SVI增加是否≥15%将患者分为有容量反应性组（R组，29例）和无容量反应性组（N组，15例）。以受试者工作特征曲线（receiver operating characteristic curve, ROC曲线）分析VIJVR与容量反应性之间的关系。 结果 气腹状态下补液前VIJVR和每搏量指数增加量（increase of stroke volume variation, △SVI）呈负相关（r=−0.451，P<0.05）。VIJVR预测容量反应性的ROC曲线下面积（area under roc curve, AUC）为 0.83（95%CI 0.705~0.950，P<0.05），以VIJVR 21%为cut‑off值预测容量反应性的敏感度和特异度分别为65.5%和93.3%。 结论 VIJVR能够较好地预测腹腔镜手术患者的容量反应性。
关键词： 颈内静脉呼吸变异度； 腹腔镜治疗； 容量反应性
Abstract:

Objective To evaluate the application of variation of internal jugular vein respiration (VIJVR) for predicting fluid responsiveness in patients undergoing laparoscopic surgery. Methods A total of 44 patients, aged 40‒65, with body mass index (BMI) of 18‒25 kg/m2, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ, were selected who received laparoscopic radical resection for rectal cancer from November 2016 to March 2017 in Northern Jiangsu People's Hospital. After patients entered into the room, their electrocardiogram (ECG), heart rate, pulse oxygen saturation (SpO2) and noninvasive blood pressure (NIBP), central vein pressure (CVP), cardiac output (CO), cardiac index (CI), stroke volume variation (SVV), and stroke volume index (SVI) were monitored. The maximum and minimum diameters of the internal jugular vein (DIJVmax and DIJVmin) were measured by ultrasound within three respiratory cycles and VIJVR was calculated as the following formula: VIJVR=［(DIJVmax−DIJVmin)/DIJVmin］×100％. Then, 10 min after the beginning of laparoscopy, 6% hydroxyethyl starch 130/0.4 (HES130/0.4, 500 ml) in sodium chloride injection water was infused at a dose of 7 ml/kg within 15 min. Meanwhile, heart rate, blood pressure, CO, CI, SVV, SVI and VIJVR were recorded 10 min after tracheal intubation (T1), 10 min after the beginning of pneumoperitoneum (T2) and 10 min after the end of infusion of 6% HES130/0.4 (T3). According to the increase of stroke volume index (△SVI) after volume challenge, the patients were divided into responders (group R, △SVI≥15%, n=29) and non‑responders (group N, △SVI<15%, n=15). The relationship between VIJVR and fluid responsiveness was analyzed by receiver operating characteristic (ROC) curve. Results The VIJVR before volume challenge was negatively related with △SVI in the presence of pneumoperitoneum (r=−0.451, P<0.05). The area under the ROC curve (AUC) of VIJVR to predict volume responsiveness was 0.83 (95%CI 0.705‒0.950, P<0.05), with a sensitivity of 65.5% and a specificity of 93.3% when the cut‑off value of VIJVR was 21% for predicting volume responsiveness. Conclusions VIJVR can well predict fluid responsiveness in patients undergoing laparoscopic surgery.
Key words: Variation of internal jugular vein respiration; Therapeutic laparoscopy; Fluid responsiveness