【摘要】 目的探讨腹部手术中锁骨下静脉呼吸变异度（SCV-CI）评估老年患者容量反应性的可行性和有效性。方法拟在全身麻醉下行择期开腹手术的老年患者63例,男43例,女20例,年龄65～82岁,ASAⅠ或Ⅱ级,心功能Ⅰ或Ⅱ级,麻醉诱导后静脉输注6%羟乙基淀粉130/0.4氯化钠注射液0.4 ml·kg^-1·min^-1,输注总量7 ml/kg,将扩容后每搏量增加值（ΔSV）≥15%的患者纳入有反应组,<15%的患者纳入无反应组。分别于扩容即刻和扩容后3 min时记录血流动力学参数,采用超声测量吸气末与呼气末锁骨下静脉内径和下腔静脉内径,记录超声测量时间,并计算SCV-CI和下腔静脉呼吸变异度（IVC-CI）,绘制受试者工作特征曲线（ROC）,并计算曲线下面积（AUC）。结果有33例（52.4%）患者纳入有反应组。扩容前后SCV-CI与IVC-CI呈正相关（r=0.804,P<0.05）,SCV-CI诊断容量反应性的AUC为0.834,界值≥25.9%时,敏感度95.6%,特异度81.3%。IVC-CI诊断容量反应性的AUC为0.893,界值≥33.7%时,敏感度93.7%,特异度88.7%。结论锁骨下静脉呼吸变异度诊断容量反应性的效能低于下腔静脉呼吸变异度,但可作为下腔静脉超声检查不便时的替代指标。更多还原

【Abstract】 Objective To explore the accuracy and feasibility of subclavian venous respiratory variability（SCV-CI） in volume responsiveness assessment of elderly patients during abdominal surgery. Methods Sixty-three elderly patients, 43 males and 20 females, aged 65-82 years, falling into ASA physical status Ⅰ-Ⅱ and cardiac function Ⅰ-Ⅱ who underwent elective laparotomy under general anesthesia were enrolled. After induction of anesthesia, intravenous infusion at a rate of 0.4 ml·kg^-1·min^-1 of 6% Hydroxyethyl starch 130/0.4 sodium chloride was given, with a total infusion volume of 7 ml/kg. Those with increased volume per stroke（ΔSV）≥15% were included in the response group, <15% were included in the non-response group. The hemodynamic parameters of the patients were recorded right after expansion and 3 min after the expansion. The inner diameter of the subclavian vein and the inferior vena cava were measured by ultrasound at the inspiration and end-tidal, ultrasonic measurement time was recorded, and SCV-CI and inferior vena cava respiratory variability（IVC-CI） were calculated. A receiver operating characteristic curve（ROC） was drawn and the area under curve（AUC） was calculated. Results There were 33（52.4%） patients in the response group. When SCV-CI ≥25.9%, the AUC was 0.834, the sensitivity was 95.6%, and the specificity was 81.3%. When IVC-CI ≥33.7%, the AUC was 0.893, the sensitivity was 93.7%, and the specificity was 88.7%. Conclusion Subclavian venous respiratory variabilitycan effectively assess the volume responsiveness of elderly patients. It can be used as an auxiliary substitute index when the ultrasound examination of inferior vena cava is inconvenient.更多还原