METHODS: Patients undergoing scheduled elective lumbar spine surgery in the prone position under general anesthesia were enrolled in the criteria of patients aged 19-75 years with American Society of Anesthesiologists (ASA) physical status I-II. The hemodynamic variables were evaluated before and after changes in posture after administering a colloid bolus (5 mL.kg-1) in the prone position. Fluid responsiveness was defined as an increase in the Stroke Volume Index (SVI) ≥ 10%.
RESULTS: A total of 28 patients were enrolled. In responders, the CPI (median [1/4Q-3/4Q]) decreased to 0.34 [0.28-0.39] W.m-2 (p = 0.035) after the prone position. After following fluid loading, CPI increased to 0.48 [0.37-0.52] W.m-2 (p < 0.008), and decreased SVI (median [1/4Q-3/4Q]) after prone increased from 26.0 [24.5-28.0] mL.m-2 to 33.0 [31.0-37.5] mL.m-2 (p = 0.014). Among non-responders, CPI decreased to 0.43 [0.28-0.53] W.m-2 (p = 0.011), and SVI decreased to 29.0 [23.5-34.8] mL.m-2 (p < 0.009). CPI exhibited predictive capabilities for fluid responsiveness as a receiver operating characteristic curve of 0.78 [95% Confidence Interval, 0.60-0.95; p = 0.025].
CONCLUSIONS: This study suggests the potential of CPI as an alternative method to existing preload indices in assessing fluid responsiveness in clinical scenarios, offering potential benefits for responders and non-responders.
方法:将在全身麻醉下进行俯卧位择期腰椎手术的患者纳入19-75岁患者的标准,这些患者的身体状态为I-II。在施用胶体推注(5mL。kg-1)在俯卧位。流体反应性定义为每搏输出量指数(SVI)增加≥10%。
结果:共纳入28例患者。在响应者中,俯卧位后,CPI(中位数[1/4Q-3/4Q])降至0.34[0.28-0.39]W.m-2(p=0.035)。流体加载后,CPI升至0.48[0.37-0.52]W.m-2(p<0.008),俯卧位从26.0[24.5-28.0]mL增加后,SVI降低(中位数[1/4Q-3/4Q])。m-2至33.0[31.0-37.5]mL。m-2(p=0.014)。在非响应者中,CPI降至0.43[0.28-0.53]W.m-2(p=0.011),SVI降至29.0[23.5-34.8]mL。m-2(p<0.009)。作为0.78[95%置信区间的接收器工作特征曲线,CPI表现出流体响应性的预测能力,0.60-0.95;p=0.025]。
结论:这项研究表明,在评估临床情景中,CPI作为现有预负荷指数的替代方法的潜力,为响应者和非响应者提供潜在的好处。