Accuracy of aortic valve velocity time integral in assessing fluid responsiveness during general anesthesia in elderly patients

Q4 Medicine

中华麻醉学杂志 Pub Date : 2019-10-20 DOI:10.3760/CMA.J.ISSN.0254-1416.2019.10.018

Li-ping Hong, K. Ma

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Abstract

Objective To evaluate the accuracy of aortic valve velocity time integral (VTI) in assessing fluid responsiveness during general anesthesia in elderly patients. Methods Forty-four elderly patients of both sexes, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, with New York Heart Association classⅠ or Ⅱ, undergoing elective surgery with general anesthesia in our hospital from February 2018 to August 2018, were enrolled in this study.All the patients underwent tracheal intubation after general anesthesia induction, and then volume expansion was carried out (6% hydroxyethyl starch 250 ml was intravenously infused for 30 min). The heart rate (HR), mean arterial pressure (MAP), VTI and stroke volume (SV) were recorded before and after volume expansion, and ΔHR, ΔMAP, ΔVTI and ΔSV were calculated.Patients were divided into 2 groups according to ΔSV: response group (R group, ΔSV≥15%) and non-response group (NR group, ΔSV<15%). The receiver operating characteristic curve (with the area under the standard ΔSV curve was 1) was used to analyze the ΔHR, ΔMAP and ΔVTI, and the Youden index at its best was calculated.The Person test was used to analyze the correlation between ΔVTI and ΔSV. Results There were 25 cases in R group and 19 cases in NR group.Compared with group NR, ΔHR was significantly decreased, and ΔVTI and ΔSV were increased in group R (P<0.05). The area under the ROC curve of ΔHR, ΔMAP and ΔVTI in assessing fluid responsiveness was 0.509 (95% confidence interval 0.314-0.689, P=0.415), 0.558 (95% confidence interval 0.379-0.737, P=0.515) and 0.905 (95% confidence interval 0.812-0.999, P<0.01), respectively. When Youden index was at its best, ΔVTI was 15.28%, with the sensitivity 88.0% and specificity 94.7%.There was a positive correlation between ΔSV and ΔVTI (r=0.936, P<0.05). Conclusion ΔVTI can accurately assess the fluid responsiveness during general anesthesia in elderly patients. Key words: Aortic valve; Aged; Fluid therapy

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主动脉瓣速度时间积分在评估老年患者全麻期间液体反应性中的准确性

目的评价主动脉瓣速度时间积分（VTI）评价老年患者全麻期间液体反应性的准确性。方法选择我院于2018年2月至2018年8月在全麻下择期手术的美国麻醉师学会身体状况Ⅰ-Ⅲ级、纽约心脏协会Ⅰ或Ⅱ级、年龄65-80岁的老年患者44例。所有患者在全麻诱导后进行气管插管，然后进行体积扩张（静脉滴注6%羟乙基淀粉250ml，持续30min）。记录容积扩张前后的心率（HR）、平均动脉压（MAP）、VTI和搏出量（SV），并计算ΔHR、ΔMAP、ΔVTI和ΔSV。根据ΔSV将患者分为2组：有反应组（R组，ΔSV≥15%）和无反应组（NR组，ΔSV<15%）。受试者工作特性曲线（标准ΔSV曲线下面积为1）用于分析ΔHR、ΔMAP和ΔVTI，并计算出最佳的尤登指数。Person检验用于分析ΔVTI和ΔSV之间的相关性。结果R组25例，NR组19例。与NR组相比，R组的ΔHR显著降低，ΔVTI和ΔSV增加（P<0.05）。ΔHR、ΔMAP和ΔVTI在评估液体反应性方面的ROC曲线下面积分别为0.509（95%置信区间0.314-0.689，P=0.415）、0.558（95%置信程度0.379-0.737，P=0.515）和0.905（95%可信区间0.812-0.999，P<0.01）。优登指数最佳时，ΔVTI为15.28%，敏感性为88.0%，特异性为94.7%，ΔSV与ΔVTI呈正相关（r=0.936，P<0.05）。关键词：主动脉瓣；老年人；液体疗法

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