摘要目的 探讨颈内静脉呼吸变异度(variability internal jugular vein,VIJV)对胃肠道手术患者术中容量反应性评估的准确性与可行性. 方法 选择拟在全身麻醉下行择期胃肠手术的患者,ASA分级Ⅰ、Ⅱ级,心功能Ⅰ级,BMI＜25 kg/m2,年龄42～74岁,麻醉诱导后以0.4 ml·kg-1·min-1的速率静脉输注6％羟乙基淀粉130/0.4氯化钠注射液,输注剂量7 ml/kg,将扩容前每搏量变异度(stroke volume variability,SVV)≥13％的患者纳入有反应组,SVV＜13％的患者纳入无反应组.共纳入60例患者,有反应组31例,无反应组29例.有反应组认为容量相对不足,无反应组认为容量充足.分别于扩容即刻和扩容后3 min时记录患者血流动力学参数(心率、SVV、CVP、MAP),采用超声仪测量吸气末与呼气末颈内静脉内径和下腔静脉内径,记录超声测量时间,并计算VIJV和下腔静脉呼吸变异度(variability inferior vena cava,VIVC).对VIJV、VIVC、SVV行Pearson相关性分析并绘制受试者工作特征曲线(receiver operating characteristic,ROC). 结果 两组患者基本情况比较差异无统计学意义(P＞0.05);与扩容前比较,有反应组扩容后HR、SVV下降,CVP、MAP上升(P＜0.05),无反应组CVP上升(P＜0.05);与扩容前比较,两组患者扩容后VIJV和VIVC降低(P＜0.05);VIJV超声测量时间明显短于VIVC超声测量时间(P＜0.05).同时,扩容前后,VUV、VIVC、SVV两两呈正相关(P＜0.05).VIJV、VIVC的受试者工作特征曲线下面积(area under the receiver operating characteristic curve,AUC)分别为0.829、0.928,诊断界值分别为18.9％、19.7％. 结论 腹部手术中VIJV≥18.9％可有效评估术中患者容量反应性,敏感度93.3％,特异度73.3％,可作为VIVC的可靠替代指标.

abstractsObjective To evaluate the accuracy and feasibility of variation of internal jugular vein respiration (VIJV) in evaluating the volume responsiveness of patients undergoing gastrointestinal surgery.Methods Patients who underwent elective gastrointestinal surgery under general anesthesia,with American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ,heart function Ⅰ,aging 42-74,body mass index (BMI)＜25 kg/m2,were infused with 6％ hydroxyethyl starch 130/0.4 NaCl injection (7 ml/kg) at a rate of 0.4 ml·kg-1·min-1 after anesthesia induction.Patients before volume expansion were classified as responders or non-responders according to the increases in the stroke volume variability (SVV) (≥ 13％ or not).The responders were thought with relatively insufficient volume,and the others were thought with sufficient volume.Sixty patients were enrolled in this study.Thirty one patients were defined as responders and the rest twenty nine were defined as non-responders.Their hemodynamic parameters (heart rate,SVV,CVP,MAP) were recorded before and 3 min after volume expanding.The diameter of the internal jugular vein and inner diameter of inferior vena cava in the end of inspiratory by ultrasonic instrument,variation of internal jugular vein respiration (VLJV) and variation of inferior vena cava respiration (VIVC) were calculated,and the ultrasonic measurement time was recorded.The VIJV,VIVC and SVV were used for Pearson's correlation analysis,and receiver operating characteristic curve (ROC) was plotted.Results There was no statistical difference in basic information between the two groups (P＞0.05).After volume expanding,the responder group showed remarkable decreases in heart rate and SVV,and marked increases in central venous pressure (CVP) and mean arterial pressure (MAP) (P＜0.05),and the non-responder group showed increased CVP (P＜0.05).Compared with before expansion,both groups demonstrated reduced VIJV and VIVC after volume expanding,with shortened VIJV ultrasonic measurement time (P＜0.05).Meanwhile,VIJV and VIVC were positively correlated with SVV (P＜0.05).The areas under ROC curve (AUC) of VIJV and VIVC were 0.829 and 0.928,and the cut off was 18.9％ and 19.7％,respectively.Conclusions The value of VIJV≥ 18.9％ during abdominal surgery can be used to effectively evaluate intraoperative patient volume reactivity,with a sensitivity of 93.3％ and a specificity of 73.3％.It can be used as an alternative index of VIVC.