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目的:比较每搏输出量变异度(SVV)和下腔静脉扩张指数(dIVC)预测全肺切除术后患者容量变化的准确性。方法:收集2014-08-2017-04我院重症医学科收治的18例全肺切除术后机械通气下需行血流动力学监测的患者,统一采用脉搏指示连续心输出量监测仪(PICCO)监测SVV,同时应用超声测量dIVC。记录补液试验前基线血流动力学参数和补液试验(7ml/kg的羟乙基淀粉)后的血流动力学参数。以CI变化量(△CI)>15%为容量治疗有反应性,将患者分为有反应组和无反应组。分别绘制SVV和dIVC的受试者工作曲线(ROC),计算曲线下面积(AUC)。结果:CVP、SVV、dIVC预测全肺切除术后机械通气患者容量反应性的AUC分别为0.604,0.893和0.863,CVP预测容量反应性无统计学意义,SVV、dIVC预测容量反应性有统计学意义(P<0.05)。结论:SVV和dIVC均是全肺切除术后行机械通气患者的容量反应性评估的可靠参数,两者均有重要的临床意义,值得推广。
OBJECTIVE: To compare the accuracy of predicting volume changes after pneumonectomy with stroke volume variation (SVV) and vena cava dilation index (dIVC). METHODS: We collected 18 patients undergoing total pneumonectomy for hemodynamic monitoring undergoing total pneumonectomy in our hospital from August 2014 to April 2017 and using the PICCO (continuous cardiac output monitor) SVV was monitored while dIVC was measured using ultrasound. The baseline hemodynamic parameters before rehydration test and hemodynamic parameters after rehydration test (7ml / kg hydroxyethyl starch) were recorded. The patients were divided into reactive group and non-responsive group with response to the change of CI (△ CI)> 15%. Subject working curves (ROCs) of SVV and dIVC were plotted separately and the area under the curve (AUC) was calculated. Results: The CV of CVP, SVV and dIVC were 0.604,0.893 and 0.863 respectively in predicting the volume responsiveness of patients undergoing mechanical ventilation after pneumonectomy. The CVP predicted volume responsiveness was not statistically significant, while the predictive capacity of SVV and dIVC was statistically significant (P <0.05). Conclusions: Both SVV and dIVC are reliable parameters for assessing volume responsiveness in patients undergoing mechanical ventilation after pneumonectomy, both of which have important clinical implications and are worthy of promotion.