摘要目的:探讨下腔静脉（IVC）呼吸变异度评估狭颅症患儿术后自主呼吸状态下液体反应性的价值。方法:选取择期全身麻醉下行狭颅症颅缝再造术患儿42例，术毕拔管后转入麻醉后监测治疗室（PACU），充分镇静镇痛后于10 min内输入5 ml/kg醋酸钠林格注射液进行扩容（VE）。以VE后心排血量（CO）增加≥10%作为评价有液体反应性的金标准，将患儿分为有液体反应性组（R组，23例）和无液体反应性组（NR组，19例）。记录并比较两组患儿的一般情况，VE前后的心率、平均压（MAP），以及VE前后经胸超声心动图（TTE）测量的IVC在自主呼吸状态下的变异度（下腔静脉塌陷指数，cIVC）和CO。绘制受试者操作特征（ROC）曲线，计算曲线下面积（AUC）以评价cIVC对液体反应性的诊断价值（临界值、敏感度、特异度）。结果:两组患儿一般情况比较，差异无统计学意义（均 P>0.05）。与VE前比较，R组患儿VE后心率和cIVC降低，MAP和CO升高（均 P<0.05）；VE前，R组患儿cIVC高于NR组（ P<0.05）；其余组内、组间比较差异无统计学意义（均 P>0.05）。ROC曲线显示cIVC预测液体反应性的AUC为0.827（95%置信区间0.679~0.926），临界值为35.6%，敏感度和特异度分别为0.74和0.84。 结论:在充分镇静镇痛条件下，IVC呼吸变异度可作为狭颅症患儿术后自主呼吸状态下判断液体反应性的指标。

abstractsObjective:To investigate the value of inferior vena cava (IVC) respiratory variation in predicting fluid responsiveness in spontaneously breathing children following craniosynostosis surgery.Methods:A total of 42 children who scheduled for craniosynostosis surgery under general anesthesia were included and transferred to the post-anesthesia care unit (PACU) after extubation. Patients were injected 5 ml/kg sodium acetate Ringer's injection within 10 min for blood volume expansion (VE) with full sedation and analgesic management. The gold standard for evaluating fluid responsiveness was cardiac output (CO)≥10%, and all patients were divided into the responder group (group R, n=23) and non-responder group (group NR, n=19). Their general information, heart rate, mean arterial pressure (MAP) before and after VE, and the variability of IVC (i.e., inferior vena cava collapse index, cIVC) and CO in the voluntary respiratory state as measured by transthoracic echocardiography (TTE) before and after VE were recorded. The receiver operating characteristic (ROC) curve of cIVC in predicting fluid responsiveness was plotted to calculate the area under the curve (AUC), cutoff value, sensitivity, and specificity. Results:There were no statistical differences between the two groups in general information (all P>0.05). Heart rate and cIVC were decreased while MAP and CO were increased in group R after VE (all P<0.05). cIVC was higher in group R than in group NR before VE ( P<0.05). No significant differences were observed in other indicators between the two groups (all P>0.05). Areas under the ROC curves of cIVC was 0.827 (95% confidence interval 0.679, 0.926) and the cutoff value was 35.6% with a sensitivity of 0.74 and a specificity of 0.84. Conclusions:With full sedation and analgesic management, IVC respiratory variation is validated in predicting fluid responsiveness in spontaneously breathing children following craniosynostosis surgery.