摘要
目的评价瓦式（Valsalva）动作过程中的肱动脉峰流速变化（ΔVp）能否预测自主呼吸患者的容量反应性。方法选择2014年12月至2016年6月宁波市鄞州人民医院需行桡动脉穿刺的择期全麻手术患者96例，超声记录瓦式动作过程中的ΔVp，随后进行容量负荷试验（VE），并记录心输出量变化（ΔCO），以容量负荷试验后CO增加≥15%为有反应组，采用Pearson相关分析对ΔVp和ΔCO做相关性研究，绘制ΔVp的受试者工作特征曲线（ROC曲线），确定ΔVp预测容量反应性的敏感度、特异度、诊断阈值及曲线下面积。结果本研究共有24例容量负荷试验有反应，72例容量负荷试验无反应。ΔVp与ΔCO具有相关性（r＝0.792，P〈0.01）。ΔVp值诊断容量反应性ROC曲线下面积为0.903（P〈0.01），其中ΔVp诊断阈值为33%，诊断容量反应性的敏感度为87%，特异度为82%。结论肱动脉峰流速结合瓦式动作可以作为预测自主呼吸患者容量反应性的指标。
Objective To evaluate whether brachial artery peak velocity variation （AVp） during a Valsalva maneuver （ VM ） could predict fluid responsiveness in spontaneously breathing patients. Methods Ninety-six patients required radial artery catheter for elective surgery of Ningbo Yinzhou People＇s Hospital from December 2014 to June 2016 were enrolled. The brachial artery Doppler signal was recorded to measure the ΔVp while the VM was performed. Then doing the volume expansion （VE） , the cardiac output variation （ACO） before and after VE were measured. Pearson correlational analyses were conducted between AVp and ACO. Also the sensitivity and specificity of AVp were determined in predicting fluid responsiveness by the receiver operating characteristic （ROC） curve. Results Patients were classified as group responders （ n = 24） and group non-responders （n = 72 ）. Responder was defined as cardiac output increased ≥ 15% after VE. The ΔVp correlated well with ΔCO （ r = 0. 792 ,P 〈 0. 01 ）. The area under ROC curve was 0. 903, with the ΔVp cut-off of 33% , the sensitivity of 87% and the specificity of 82% （ P 〈 0. 01 ） . Conclusion Brachial artery peak velocity variation during a valsalva maneuver is a feasible method for predicting fluid responsiveness in spontaneously breathing patients
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第6期434-437,共4页
National Medical Journal of China
关键词
肱动脉
血流速度
瓦式动作
呼吸
肺容量测定
Brachial- artery
-Blood flow velocity
Valsalva maneuver
Respiration
Lung volume measurements
