摘要目的 评估脉搏灌注指数变异(PVI)在全身麻醉机械通气条件下预测患者容量治疗反应、评估容量状况的能力.方法 2009年8月至11月选择25例美国麻醉医师协会分级Ⅰ～Ⅱ级拟在全身麻醉下行腹部手术的患者,年龄25～74岁,麻醉诱导后连续监测平均动脉压、心率、中心静脉压、心指数(CI)、每搏输出量变异度(SW)、PVI、灌注指数(PI)等血流动力学指标,以0.4 ml·kg-1·min-1的速率静脉输注6%羟乙基淀粉(130/0.4)注射液,输注总量:7 ml/kg,将CI增加百分比(△CI)≥15%视为对容量治疗有反应.结果 对容量治疗有反应的患者SVV基础值16.0%±2.6%显著高于对容量治疗无反应患者的11.6%±1.4%(P＜0.05);对容量治疗有反应的患者PVI基础值20.5%±3.7%也显著高于对容量治疗无反应患者的13.8%±2.6%(P＜0.05);SVV诊断阈值为13.5%,监测容量反应的灵敏度为88.2%,特异度为87.5%;PVI的诊断阈值为15.5%,监测容量反应的灵敏度为88.2%,特异度为87.5%;Pearson相关性分析显示:SVV的基础值与△CI相关系数r=0.600(P＜0.01),PVI的基础值与△CI相关系数r=0.683(P＜0.01).结论 PVI,脉搏灌注指数周期性的变异能够预测机械通气患者在安静状态下的容量治疗反应,其准确性与有创测得的SVV相类似.

abstractsObjective To evaluate the ability of pleth variability index (PVI) in predicting fluid responsiveness in mechanically ventilated patients under general anesthesia. Methods From August to November 2009, 25 patients were enclosed in this study following anesthesia induction. PVI was continuously displayed by the Masimo Radical 7. All patients were also monitored with Vigileo/FloTrac system.Haemodynamic data such as cardiac index ( CI ), stroke volume variability(SVV), mean arterial pressure,heart rate,central venous pressure,PVI,perfusion index were recorded before and after volume expansion (hetastar 6% ,7 ml/kg). Fluid responsiveness was defined as an increase in CI ≥ 15% (△CI ≥ 15 ). Results SVV and PVI were significantly higher in the responders ( 16. 0% ±2. 6% and 20. 5% ±3.7% ) than those in non-responders ( 11.6% ± 1.4% and 13. 8% ± 2. 6% ) respectively ( P ＜ 0. 05 ). The SVV threshold of 13.5% before volume expansion was able to discriminate the responders from the non-responders with a sensitivity of 88. 2% and a specificity of 87.5%. The threshold for PVI was 15.5% ,the same sensitivity of 88.2% and specificity of 87.5% were obtained. There was a significant relationship between PVI before volume expansion and change in CI after volume expansion( r =0. 683, P ＜0. 01 ) ,the same as the changes of SVV(r =0. 600, P ＜0. 01 ). Conclusion PVI as a new dynamic indices can predict fluid responsiveness non-invasively in mechanically ventilated patients during general anesthesia.