老年胃肠道全麻手术患者颈动脉超声指标与每搏量变异度变化的相关性

张雪寅; 骆宏; 陈立建

doi:10.16766/j.cnki.issn.1674-4152.003327

老年胃肠道全麻手术患者颈动脉超声指标与每搏量变异度变化的相关性

doi: 10.16766/j.cnki.issn.1674-4152.003327

1.
合肥市第一人民医院麻醉科，安徽合肥 230061
2.
安徽医科大学第一附属医院麻醉科，安徽合肥 230022

基金项目:

中国初级卫生保健基金会项目(横向课题) YLGX-WS-2020001

合肥市卫生计生委2017年应用医学研究项目 hwk2017zd011

详细信息

通讯作者:
骆宏，E-mail：lhxy816@sina.com

中图分类号: R614.2 R656.6
计量
- 文章访问数: 181
- HTML全文浏览量: 66
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-14
- 网络出版日期: 2024-03-09

The correlation between carotid artery ultrasound index and stroke variability in elderly patients undergoing general gastrointestinal anesthesia

1.
Department of Anesthesiology, Hefei First People's Hospital, Hefei, Anhui 230061, China

摘要

摘要: 目的评估颈动脉校正血流时间(FTc)和颈动脉峰流速变异度(ΔVpeak)对老年胃肠道手术患者全麻诱导机械通气时每搏量变异度(SVV)≥13%的预测能力。方法选取合肥市第一人民医院于2021年7月—2022年12月行腹腔镜胃肠道手术的患者60例。于气管插管后5 min(T1)测定超声参数和血流动力学参数。SVV≥13%为容量有反应组(R组)；SVV < 13%为容量无反应组(N组)，各纳入30例患者。完成容量负荷试验后5 min(T2)，再次测量相同的血流动力学参数。采用Pearson相关性分析研究超声参数与SVV的相关性，采用ROC曲线评估FTc和ΔVpeak预测SVV≥13%的能力。结果 R组患者麻醉诱导前(T0)至T2时点FTc明显低于N组患者，而ΔVpeak明显高于N组患者，差异均有统计学意义(P＜0.05)。2组患者T2时点FTc明显高于同组T0时点，而T2时点ΔVpeak明显低于同组T0时点，差异均有统计学意义(P＜0.05)。FTc预测SVV≥13%的灵敏度为83.3%，特异度为76.7%；ΔVpeak预测SVV≥13%的灵敏度为80.0%，特异度为63.3%。FTc与SVV的相关性系数为-0.674，表明FTc和SVV呈负相关关系；ΔVpeak与SVV的相关性系数为0.765，表明ΔVpeak和SVV呈正相关关系。结论 FTc、ΔVpeak与SVV具有良好的相关性。FTc和ΔVpeak均能预测老年患者全麻期间的容量反应性。
- 颈动脉校正血流时间 /
- 颈动脉峰流速变异度 /
- 每搏变异度 /
- 全身麻醉 /
- 老年
Abstract: Objective To evaluate the predictive ability of carotid corrected flow time (FTc) and carotid peak flow variability (ΔVpeak) for stroke volume variation (SVV) ≥13% during induction of mechanical ventilation under general anaesthesia in elderly patients. Methods A total of 60 patients undergoing laparoscopic gastrointestinal surgery at Hefei First People's Hospital from July 2021 to December 2022 were selected. The ultrasound parameters and hemodynamic parameters were measured 5 min after endotracheal intubation (T1). SVV≥13% was defined as responder group (R group); SVV < 13% was defined as non-responder group (N group). Finally, 30 patients were included in the R and N group, respectively. Five minutes after the volume loading test(T2), the same hemodynamic parameters were measured. Pearson correlation coefficient was used to analyze the correlation between ultrasound parameters and SVV. ROC curve was used to evaluate the ability of FTc and ΔVpeak to predict SVV≥13%. Results FTc in group R was significantly lower than that in group N from T0 (before induction of anesthesia) to T2, while ΔVpeak was significantly higher than that in group N (P < 0.05). FTc at T2 was significantly higher than that at T0, whereas ΔVpeak at T2 was significantly lower than that at T0 in both groups (P < 0.05). FTc predicted SVV≥13% with 83.3% sensitivity and 76.7% specificity. ΔVpeak predicted SVV≥13% with 80.0% sensitivity and 63.3% specificity. Pearson correlation analysis showed that the correlation coefficient between FTc and SVV was -0.674, indicating a negative correlation between FTc and SVV. The correlation coefficient between ΔVpeak and SVV was 0.765, indicating that there was a positive correlation between ΔVpeak and SVV. Conclusion FTc and ΔVpeak correlate well with SVV. Both FTc and ΔVpeak can predict fluid responsiveness during general anaesthesia in elderly patients.
- Carotid corrected blood flow time /
- Carotid peak flow variability /
- Stroke volume variation /
- General anesthesia /
- Elderly

HTML全文

图 1 FTc预测SVV≥13%的ROC曲线

Figure 1. ROC curve of FTc predicted SVV≥13%

下载: 全尺寸图片幻灯片

图 2 ΔVpeak预测SVV≥13%的ROC曲线

Figure 2. ROC curve of ΔVpeak predicted SVV≥13%

下载: 全尺寸图片幻灯片

表 1 2组腹腔镜胃肠道手术患者一般情况比较

Table 1. Comparison of general conditions between the two groups of patients undergoing laparoscopic gastrointestinal surgery

组别	例数	年龄(x±s, 岁)	性别 (男性/女性, 例)	BMI(x±s)	ASA分级 (Ⅱ/Ⅲ, 例)	手术部位 (胃部/肠道, 例)	高血压 [例(%)]	糖尿病 [例(%)]	冠心病 [例(%)]
R组	30	70.8±3.9	16/14	21.7±3.0	18/12	13/17	10(33.3)	9(30.0)	5(16.7)
N组	30	71.0±3.5	13/17	22.2±2.8	15/15	16/14	8(26.7)	9(30.0)	6(20.0)
统计量		0.209^a	0.601^b	0.667^a	0.606^b	0.601^b	0.317^b		0.111^b
P值		0.835	0.438	0.507	0.436	0.438	0.573		0.739
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 2 2组腹腔镜胃肠道手术患者各时间点血流动力学指标比较(x±s)

Table 2. Comparison of hemodynamic indexes at each time point between the two groups of patients undergoing laparoscopic gastrointestinal surgery (x±s)

组别	例数	MAP(mmHg)			F值	P值	HR(次/min)			F值	P值
组别	例数	T0	T1	T2	F值	P值	T0	T1	T2	F值	P值
R组	30	90.4±7.6	74.7±6.5^a	84.2±7.1^a	37.413	＜0.001	79.2±7.3	73.4±5.6^a	78.4±6.7	6.864	0.002
N组	30	90.0±7.3	79.8±7.0^a	85.1±7.3^a	15.054	＜0.001	78.7±7.1	76.9±5.9^a	78.0±6.5	0.581	0.561
F值		0.208	2.924	0.484			0.269	2.357	0.235
P值		0.836	0.005	0.630			0.789	0.022	0.815
注：与同组T0时点比较，^aP＜0.05。

下载: 导出CSV

表 3 2组腹腔镜胃肠道手术患者各时间点颈动脉超声指标比较(x±s)

Table 3. Comparison of carotid ultrasound indexes at each time point between the two groups of patients undergoing laparoscopic gastrointestinal surgery (x±s)

组别	例数	FTc(ms)			F值	P值	ΔVpeak(%)			F值	P值
组别	例数	T0	T1	T2	F值	P值	T0	T1	T2	F值	P值
R组	30	335.5±9.7	331.0±11.4	356.1±8.8^a	53.473	＜0.001	11.1±1.5	11.9±1.4	8.7±1.5^a	38.641	＜0.001
N组	30	347.8±10.2	344.1±8.2	365.7±9.4^a	46.264	＜0.001	9.3±1.2	9.9±1.1	7.2±1.1^a	46.874	＜0.001
F值		4.786	5.110	4.084			5.132	6.153	4.417
P值		＜0.001	＜0.001	＜0.001			＜0.001	＜0.001	＜0.001
注：与T0时点比较，^aP＜0.05。

下载: 导出CSV

表 4 FTc、ΔVpeak预测SVV≥13%的ROC曲线分析结果

Table 4. ROC curve analysis results of FTc and ΔVpeak predicted SVV≥13%

项目	约登指数	灵敏度 (%)	特异度 (%)	AUC	95% CI
FTc	0.600	83.3	76.7	0.818	0.706~0.931
ΔVpeak	0.379	80.0	63.3	0.855	0.764~0.946

下载: 导出CSV

参考文献(20)

[1]	ACETO P, ANTONELLI INCALZI R, BETTELLI G, et al. Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus[J]. Aging Clin Exp Res, 2020, 32(9): 1647-1673. doi: 10.1007/s40520-020-01624-x
[2]	林丹欣, 杜斌. 急性肾损伤患者液体超负荷与预后的关系[J]. 中国医药, 2022, 17(12): 1822-1826. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202212014.htm LIN D X, DU B. Association between fluid overload and outcomes in patients with acute kidney injury[J]. China Medicine, 2022, 17(12): 1822-1826. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202212014.htm
[3]	金晶, 周一农, 姜明, 等. 结直肠癌切除术中以目标导向方式输注胶体液对近期恢复和免疫功能的影响[J]. 中华全科医学, 2021, 19(9): 1593-1596. doi: 10.16766/j.cnki.issn.1674-4152.002119 JIN J, ZHOU Y N, JIANG M, et al. Effects of goal-directed colloid infusion on short-term recovery and immune function during colorectal cancer resection[J]. Chinese Journal of General Practice, 2021, 19(9): 1593-1596. doi: 10.16766/j.cnki.issn.1674-4152.002119
[4]	李振平, 袁孝忠, 曹婧, 等. 不同头低位腹腔镜手术对患者血流动力学及心功能的影响[J]. 浙江临床医学, 2020, 22(2): 208-210. https://www.cnki.com.cn/Article/CJFDTOTAL-YCGC202104033.htm LI Z P, YUAN X Z, CAO J, et al. Effect of different steep trendelenburg positions surgery on hemodynamics and cardiac function[J]. Zhejiang Clinical Medical Journal, 2020, 22(2): 208-210. https://www.cnki.com.cn/Article/CJFDTOTAL-YCGC202104033.htm
[5]	杨娜, 谢永鹏, 刘克喜. 颈动脉校正血流时间及颈动脉峰流速变异度预测感染性休克病人容量反应性的研究[J]. 安徽医药, 2021, 25(12): 2416-2420. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYY202112020.htm YANG N, XIE Y P, LIU K X. A study of carotid artery correction flow time and carotid peak flow variability in predicting volume responsiveness in septic shock patients[J]. Anhui Medical and Pharmaceutical Journal, 2021, 25(12): 2416-2420. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYY202112020.htm
[6]	WANG J, LI Y, SU H, et al. Carotid artery corrected flow time and respiratory variations of peak blood flow velocity for prediction of hypotension after induction of general anesthesia in elderly patients[J]. BMC Geriatr, 2022, 22(1): 882. doi: 10.1186/s12877-022-03619-x
[7]	MAITRA S, BAIDYA D K, ANAND R K, et al. Carotid artery corrected flow time and respiratory variations of peak blood flow velocity for prediction of hypotension after induction of general anesthesia in adult patients undergoing elective surgery: a prospective observational study[J]. J Ultrasound Med, 2020, 39(4): 721-730. doi: 10.1002/jum.15151
[8]	MOHAMMADINEJAD P, HOSSEIN-NEJAD H. Calculation of corrected flow time: Wodey's formula vs. Bazett's formula[J]. J Crit Care, 2018, 44: 154-155. doi: 10.1016/j.jcrc.2017.10.046
[9]	XU L, DAI S, SHEN J, et al. The predictive ability of carotid artery corrected flow time and respirophasic variation in blood flow peak velocity measured by ultrasonography for fluid responsiveness in parturients for cesarean delivery[J]. Minerva Anestesiol, 2020, 86(10): 1039-1046.
[10]	薛梅, 罗婷, 吴安石. 胸科手术中影响每搏变异度反应容量准确性的因素[J]. 国际麻醉学与复苏杂志, 2020, 41(11): 1086-1090. XUE M, LUO T, WU A S. Influencing factors of predictive accuracy of stroke volume variation during thoracic surgery[J]. International Journal of Anesthesiology and Resuscitation, 2020, 41(11): 1086-1090.
[11]	FISCHER A, MENGER J, MOUHIEDDINE M, et al. Stroke volume and arterial pressure fluid responsiveness in patients with elevated stroke volume variation undergoing major vascular surgery: a prospective intervention study[J]. J Cardiothorac Vasc Anesth, 2023, 37(3): 407-414. doi: 10.1053/j.jvca.2022.11.028
[12]	SAHUTOGLU C, TURKSAL E, KOCABAS S, et al. Influence of stroke volume variation on fluid treatment and postoperative complications in thoracic surgery[J]. Ther Clin Risk Manag, 2018, 14: 575-581. doi: 10.2147/TCRM.S154093
[13]	ALVARADO SÁNCHEZ J I, CAICEDO RUIZ J D, DIAZTAGLE FERNÁNDEZ J J, et al. Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and meta-analysis[J]. Ann Intensive Care, 2021, 11(1): 28. doi: 10.1186/s13613-021-00817-5
[14]	张建友, 孟祎凡, 何燕, 等. 每搏量变异度导向液体治疗对腹腔镜胃癌根治术患者肠屏障功能的影响[J]. 中国临床医学, 2022, 29(4): 559-564. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202204007.htm ZHANG J Y, MENG Y F, HE Y, et al. Effect of stroke volume variation guided fluid therapy on intestinal barrier function in patients undergoing radical gastrectomy[J]. Chinese Journal of Clinical Medicine, 2022, 29(4): 559-564. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202204007.htm
[15]	HUAN S, DAI J, SONG S, et al. Stroke volume variation for predicting responsiveness to fluid therapy in patients undergoing cardiac and thoracic surgery: a systematic review and meta-analysis[J]. BMJ Open, 2022, 12(5): e051112. DOI: 10.1136/bmjopen-2021-051112.
[16]	KIMURA A, SUEHIRO K, JURI T, et al. Changes in corrected carotid flow time induced by recruitment maneuver predict fluid responsiveness in patients undergoing general anesthesia[J]. J Clin Monit Comput, 2022, 36(4): 1069-1077. doi: 10.1007/s10877-021-00736-7
[17]	XU L, DAI S, SHEN J, et al. The predictive ability of carotid artery corrected flow time and respirophasic variation in blood flow peak velocity measured by ultrasonography for fluid responsiveness in parturients for cesarean delivery[J]. Minerva Anestesiol, 2020, 86(10): 1039-1046.
[18]	KIM D H, SHIN S, KIM N, et al. Carotid ultrasound measurements for assessing fluid responsiveness in spontaneously breathing patients: corrected flow time and respirophasic variation in blood flow peak velocity[J]. Br J Anaesth, 2018, 121(3): 541-549. doi: 10.1016/j.bja.2017.12.047
[19]	ZHANG Y, CAO J, ZHOU J, et al. Plaque elasticity and intraplaque neovascularisation on carotid artery ultrasound: a comparative histological study[J]. Eur J Vasc Endovasc Surg, 2021, 62(3): 358-366. doi: 10.1016/j.ejvs.2021.05.026
[20]	SINGLA D, GUPTA B, VARSHNEY P, et al. Role of carotid corrected flow time and peak velocity variation in predicting fluid responsiveness: a systematic review and meta-analysis[J]. Korean J Anesthesiol, 2023, 76(3): 183-193. doi: 10.4097/kja.22385