开颅手术患儿液体治疗时每搏量变异度与脉压变异度的相关性

Association between stroke volume variation and pulse pressure variation in goal-directed fluid therapy for children undergoing craniotomy

中文关键词: 目标导向液体治疗  每搏量变异度  脉压变异度  开颅手术  儿童

英文关键词: Goal-directed fluid therapy  Stroke volume variation  Pulse pressure variation  Craniotomy  Child

中文摘要:

      
目的 探讨开颅手术实施传统液体治疗和目标导向液体治疗（GDFT）时，患儿每搏量变异度（SVV）与脉压变异度（PPV）的相关性。
方法 择期行开颅手术患儿60例，男33例，女27例，年龄1～5岁，体重≤20 kg，ASA Ⅰ或Ⅱ级。术中PPV＞15%且超过1 min时启动GDFT，给予6%羟乙基淀粉（130/0.4） 3 ml/kg，10 min内静脉快速输注，如有必要可重复输注。未达启动目标的患儿仍然采用传统的“4-2-1”输液法补充术中液体丢失量。根据患儿是否启GDFT分为：GDFT组和对照组。记录手术开始时（T1）、钻颅孔前（T2）、切开硬脑膜前（T3）、切除肿瘤后（T4）、缝合硬脑膜前（T5）、固定骨瓣前（T6）、手术结束时（T7）的SVV和PPV，采用Pearson检验分析SVV与PPV的相关性。
结果 T1—T7时所有患儿SVV与PPV相关系数分别为0.747、0.657、0.376、0.330、0.377、0.333和0.533（P<0.05）。共有31例（52%）患儿术中启动GDFT。T1—T7时，GDFT组SVV与PPV的相关系数分别为0.815、0.593、0.443、0.362、0.403、0.466和0.463，对照组SVV与PPV的相关系数分别为0.665、0.705、0.282、0.316、0.319、0.241和0.655。
结论 在开颅手术液体治疗时，患儿SVV与PPV相关性较差，不建议用SVV取代PPV作为启动GDFT的指标。

英文摘要:

      
Objective To evaluate the correlation between stroke volume variability (SVV) and pulse pressure variability (PPV) during traditional fluid therapy and goal-directed fluid therapy (GDFT) for children undergoing craniotomy.
Methods Sixty children undergoing elective craniotomy, 33 males and 27 females, aged 1-5 years, weighing ≤ 20 kg, ASA physical status Ⅰ or Ⅱ were included. GDFT started when PPV was more than 15% and lasted more than 1 minute, and 6% hydroxyethyl starch (130/0.4) 3 ml/kg was given intravenously within 10 minutes. If necessary, the infusion could be repeated. If the children did not accord with GDFT conditions, traditional fluid therapy of “4-2-1” principle was used. Children were civided into GDFT group and control group according to whether or not they were received GDFT. SVV and PPV were recorded at the beginning of operation (T1), before skull drilling (T2), before dural incision (T3), after tumor resection (T4), before dural suture (T5), before cranial flap fixation (T6), and the end of operation (T7). Pearson test was used to analyze the correlation between SVV and PPV.
Results The correlation coefficients of SVV and PPV for all sixty children at T1-T7 were 0.747, 0.657, 0.376, 0.330, 0.377, 0.333, and 0.533. Thirty-one (52%) GDFT group during operation in total. The correlation coefficients of SVV and PPV for GDFT group at T1-T7 were 0.815, 0.593, 0.443, 0.362, 0.403, 0.466, and 0.463, respectively. For control group at T1-T7 were 0.665, 0.705, 0.282, 0.316, 0.319, 0.241, and 0.655, respectively.
Conclusion There is a poor correlation between SVV and PPV in fluid therapy for pediatric undergoing craniotomy. It is not recommended that using SVV instead of PPV as an indicator for initiating GDFT.