俯卧位下呼气末正压对动态性血流动力学指标预测容量准确性及阈值的影响

发布时间：2018-06-24 20:07

本文选题：呼气末正压 + 俯卧位　；参考：《中国人民解放军医学院》2015年硕士论文

【摘要】：目的观察俯卧位下应用不同呼气末正压(PEEP)条件下对每搏量变异度(SW)、脉搏压变异度(PPV)及脉搏灌注变异指数(PVI)预测容量状态的准确性及诊断阈值的影响。方法选择在全麻下俯卧位行腰椎手术患者60例,全麻后连续监测每SVV、PPV、PVI等血流动力学参数并记录数值,改俯卧位后,待血流动力学稳定,分别加以0、5、10、15 cmH20的PEEP,记录每个PEEP时点的各血流动力学参数值,然后以7ml/kg进行补液试验后,再分别加以0、5、10、15 cmH2O的PEEP值后记录输液后相应的血流动力学参数值。然后以输液前后每搏量变异指数的差值(△SVI)将患者分为两组,即有反应组(△SVI≥15%)和无反应组(△SVI15%)组,分别绘制SVV、PPV和PVI在不同PEEP条件下判断扩容效应的受试者工作特征性(R0C)曲线,确定俯卧位时不同PEEP值对SVV、PPV和PV I预测容量状况的准确性、诊断阈值及其相关性的影响。结果与平卧位相比较,俯卧位条件下SVV、PPV、PVI均增大(P0.05),平均动脉压(MAP)降低(P0.05),心率(HR)、每搏量(SV)、每搏量指数(SVI)、心输出量(c0)、心指数(CI)差异无统计学意义(P0.05)。俯卧位时,在PEEP=0、5、 10、15cmH20条件下,SVV判断扩容有效的ROC曲线下面积分别为0.864、0.759、0.718、0.521,PPV判断扩容有效的ROC曲线下面积分别为0.873、0.792、0.705、0.505,PVI判断扩容有效的ROC曲线下面积分别为0.851、0.765、0.709、0.512。当PEEP=0 cmH20时,SVV、PPV、PVI诊断阈值分别为10.5、11.5、13.5,当PEEP=5 cmH2O时,SVV、PPV、PVI诊断阈值分别为11.5、13.5、14.5,当PEEP=10cmH20时，，SVV、PPV、PVI诊断阈值分别为13.5、14.5、16.5,在PEEP=15 cmH20时,SVV、PPV、PVI的曲线下面积均小于0.7,诊断意义较差,因此未计算诊断阈值。俯卧位时在不同PEEP条件下SVV、PPV、PVI变化分别与PEEP值变化呈正相关(r分别为0.424、0.561、0.553,P0.01)。结论1. SVV、PPV和PVI在PEEP≤10cmH20时可以准确预测俯卧位下全麻机械通气患者的容量状况;在PEEP=15cmH20时,SVV、PPV和PVI不能准确预测俯卧位下全麻机械通气患者的容量状况。2.俯卧位时，SVV、PPV和PVI的诊断阈值随PEEP值增大而增大，而诊断的准确性随PEEP值增大而下降。3.俯卧位时SVV、PPV, PVI数值均与PEEP值增加呈正相关变化。
[Abstract]:Objective To observe the accuracy of measurement of volume variation (SW), pulse pressure variability (PPV) and pulse perfusion variation index (PVI) in the prone position under the condition of different end expiratory pressure (PEEP), and the effect of the diagnostic threshold. Methods 60 patients with lumbar spine surgery under general anesthesia were selected, and every SVV, PPV, PVI after general anesthesia was continuously monitored. After changing the hemodynamic parameters and recording the values, the hemodynamics was stable and the PEEP of 0,5,10,15 cmH20 was used to record the hemodynamic parameters of each PEEP point at each time, and then the fluid dynamic parameters were recorded after the 0,5,10,15 cmH2O PEEP value followed by 7ml/kg. Then, the patients were divided into two groups, namely, the response group (delta SVI > 15%) and the non reactive group (delta SVI15%) group, which were divided into two groups, namely, the SVV, PPV and PVI, respectively, to determine the working characteristic (R0C) curves of the subjects under the different PEEP conditions to determine the dilatancy effect, and determine the different PEEP values for SVV, PPV and PV. The accuracy of the capacity condition, the diagnostic threshold and its correlation. Compared with the supine position, SVV, PPV, PVI were all increased (P0.05), mean arterial pressure (MAP), heart rate (HR), heart rate (SV), per stroke index (SVI), cardiac output (C0), cardiac index (CI) were not statistically significant (P0.05). Prone position, in the prone position Under the condition of 0,5 and 10,15cmH20, the area of the effective ROC curve under SVV is 0.864,0.759,0.718,0.521, and the area under the ROC curve which is valid by the PPV is 0.873,0.792,0.705,0.505, and the area under the ROC curve which is valid is 0.851,0.765,0.709,0.512. when PEEP=0. For 10.5,11.5,13.5, when PEEP=5 cmH2O, the diagnostic threshold of SVV, PPV, PVI is 11.5,13.5,14.5 respectively. When PEEP=10cmH20, SVV, PPV, PVI diagnostic threshold is 13.5,14.5,16.5, the area under the curve is less than 0.7, the diagnostic significance is poor, so the diagnostic threshold is not calculated. The changes of V and PVI were positively correlated with the change of PEEP value (R respectively 0.424,0.561,0.553, P0.01). Conclusion 1. SVV, PPV and PVI can accurately predict the capacity status of patients with general anesthesia in the prone position when PEEP < < 10cmH20 >. When the prone position, the diagnostic threshold of SVV, PPV and PVI increases with the increase of PEEP value, and the accuracy of diagnosis with the PEEP value increases and the.3. prone position decreases, SVV, PPV, PVI values are positively correlated with the increase of PEEP value.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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