目的:本研究旨在确定颈动脉血流量(CABF)的预测价值,校正颈动脉血流时间(CFT),在接受冠状动脉旁路移植术(CABG)的机械通气患者中,颈动脉收缩期峰值速度(DVPeakCA)的呼吸变化对液体反应的影响。它还旨在将这些指数中的每一个与流体推注后的每搏输出量指数(SVI)的变化相关联。
方法:这种前瞻性,介入,研究前后招募了45例接受CABG的成年患者.麻醉诱导后,在10分钟内递送6ml/kg的类晶体溶液的流体挑战。平均动脉压(MAP),心率(HR),中心静脉压(CVP),CABF,CFT,在干预前后记录DVPeakCA.SVI从基线增加>15%的患者被认为是应答者。
结果:我们有22名应答者和23名无应答者。所研究指标(CABF,0.516,CFT,0.502和DVPeakCA,0.671)未提示检测液体反应性的任何强预测值。同样,这些颈动脉多普勒指数的相关性的r值,基线和与SVI变化%相比的基线变化均<0.2,这表明这些变量之间的相关性非常弱.
结论:颈动脉多普勒指数不可靠,并且不能取代分析预加载优化的侵入性方法。颈动脉多普勒得出的指数与液体推注前后SVI的改变之间没有显着相关性。
OBJECTIVE: This study aimed to determine the predictive value of carotid artery blood flow (CABF), corrected carotid flow time (CFT), and respiratory variation in carotid peak systolic velocity (DVPeakCA) for fluid responsiveness in mechanically ventilated patients undergoing coronary artery bypass grafting (CABG) surgery. It also aimed to correlate each of these indices with changes in stroke volume index (SVI) after a fluid bolus.
METHODS: This prospective, interventional, before-after study recruited 45 adult patients undergoing CABG. Following induction of anesthesia, a fluid challenge of 6 ml/kg of a crystalloid solution was delivered over 10 min. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), CABF, CFT, and DVPeakCA were recorded before and following the intervention. Patients with an increase in SVI of >15% from baseline were considered responders.
RESULTS: We had 22 responders and 23 nonresponders. Areas under the receiver operating characteristic (AUROC) curves for the studied indices (CABF, 0.516, CFT, 0.502, and DVPeakCA, 0.671) did not suggest any strong predictive value to detect fluid responsiveness. Similarly, the r values for correlation of these carotid doppler-derived indices, both baseline and as % change from baseline with the % alteration of SVI were all <0.2, which demonstrates a very weak correlation between these variables.
CONCLUSIONS: Carotid doppler indices are unreliable to assess fluid responsiveness, and cannot replace invasive methods of analyzing preload optimization. There was no significant correlation between carotid doppler-derived indices and alterations in SVI before and after the fluid bolus.