背景:这项研究的目的是测试脉搏波传导时间(PWTT)对液体反应性的预测价值,与已建立的液体反应性参数脉压(ΔPP)和校正的流量时间(FTc)相比腹部大手术期间。
方法:对40例腹部大手术患者进行PWTT连续监测(LifeScope®ModellJBSM-9101NihonKohdenEuropeGmbH,罗斯巴赫,德国)和中风量(食管多普勒监测心脏Q-ODM®,Deltex医疗有限公司,奇切斯特,英国)。在低血容量的情况下(脉压差[ΔPP]≥9%,校正的流动时间[FTc]≤350ms)给予7ml/kg理想体重的液体推注。使用受试者工作特征(ROC)曲线和相应的曲线下面积(AUC)来比较确定PWTT的不同方法。使用Wilcoxon检验将流体反应者(每搏输出量增加≥10%)与非反应者区分开。通过测试PWTT的ROC曲线之间的差异,比较了PWTT对液体反应性的预测价值。ΔPP和FTc使用DeLong的方法。
结果:预测PWTT参数的流体反应性的AUC(ROC曲线下面积)为0.61(原始c指Q),0.61(原始c指R),0.57(原始c耳Q),0.53(原始c耳R),0.54(原始非C指Q),0.52(原始非C指R),0.50(原始非C耳Q),0.55(原始非c耳R),0.63(Δc手指Q),0.61(Δc手指R),0.64(Δc耳Q),0.66(Δc耳R),0.59(Δ非c指Q),0.57(Δ非c指R),0.57(Δ非c耳Q),0.61(Δ非c耳R)[原始测量值与Δ=呼吸变化;c=根据Bazett公式校正的测量值与非c=未校正测量;Qvs.R=开始PWTT测量-心电图中的Q波或R波;手指与耳=脉搏血氧饱和度探头位置]。因此,用PWTT预测液体反应性的最高AUC是通过计算其呼吸变异度(ΔPWTT)来实现的,耳垂上附有脉搏血氧计,使用心电图中的R波,并通过Bazett公式进行校正(AUC最佳-PWTT0.66,95%CI0.54-0.79)。ΔPWTT足以区分液体反应者和非反应者(p=0.029)。最佳PWTT和ΔPP在预测液体反应性方面没有差异(AUC0.65,95%CI0.51-0.79;p=0.88),或最佳PWTT和FTc(AUC0.62,95%CI0.49-0.75;p=0.68)。
结论:ΔPWTT在术中预测液体反应性的能力较差。此外,建立的替代方案ΔPP和FTc表现不佳。
背景:在clinicaltrials.gov(NCT03280953;注册日期2017年9月13日)上注册之前。
Aim of this study is to test the predictive value of Pulse Wave Transit Time (PWTT) for fluid responsiveness in comparison to the established fluid responsiveness parameters pulse pressure (ΔPP) and corrected flow time (FTc) during major abdominal surgery.
Forty patients undergoing major abdominal surgery were enrolled with continuous monitoring of PWTT (LifeScope® Modell J BSM-9101 Nihon Kohden Europe GmbH, Rosbach, Germany) and stroke volume (Esophageal Doppler Monitoring CardioQ-ODM®, Deltex Medical Ltd, Chichester, UK). In case of hypovolemia (difference in pulse pressure [∆PP] ≥ 9%, corrected flow time [FTc] ≤ 350 ms) a fluid bolus of 7 ml/kg ideal body weight was administered. Receiver operating characteristics (ROC) curves and corresponding areas under the curve (AUCs) were used to compare different methods of determining PWTT. A Wilcoxon test was used to discriminate fluid responders (increase in stroke volume of ≥ 10%) from non-responders. The predictive value of PWTT for fluid responsiveness was compared by testing for differences between ROC curves of PWTT, ΔPP and FTc using the methods by DeLong.
AUCs (area under the ROC-curve) to predict fluid responsiveness for PWTT-parameters were 0.61 (raw c finger Q), 0.61 (raw c finger R), 0.57 (raw c ear Q), 0.53 (raw c ear R), 0.54 (raw non-c finger Q), 0.52 (raw non-c finger R), 0.50 (raw non-c ear Q), 0.55 (raw non-c ear R), 0.63 (∆ c finger Q), 0.61 (∆ c finger R), 0.64 (∆ c ear Q), 0.66 (∆ c ear R), 0.59 (∆ non-c finger Q), 0.57 (∆ non-c finger R), 0.57 (∆ non-c ear Q), 0.61 (∆ non-c ear R) [raw measurements vs. ∆ = respiratory variation; c = corrected measurements according to Bazett\'s formula vs. non-c = uncorrected measurements; Q vs. R = start of PWTT-measurements with Q- or R-wave in ECG; finger vs. ear = pulse oximetry probe location]. Hence, the highest AUC to predict fluid responsiveness by PWTT was achieved by calculating its respiratory variation (∆PWTT), with a pulse oximeter attached to the earlobe, using the R-wave in ECG, and correction by Bazett\'s formula (AUC best-PWTT 0.66, 95% CI 0.54-0.79). ∆PWTT was sufficient to discriminate fluid responders from non-responders (p = 0.029). No difference in predicting fluid responsiveness was found between best-PWTT and ∆PP (AUC 0.65, 95% CI 0.51-0.79; p = 0.88), or best-PWTT and FTc (AUC 0.62, 95% CI 0.49-0.75; p = 0.68).
ΔPWTT shows poor ability to predict fluid responsiveness intraoperatively. Moreover, established alternatives ΔPP and FTc did not perform better.
Prior to enrolement on clinicaltrials.gov (NC T03280953; date of registration 13/09/2017).