Page 13 - 麻醉与监护论坛2015年第4期

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constant, inotropes or vasopressors were injected in a stable
dose by microinfusion pump if necessary, stimulation
of the patients was avoided, and no external fluids were
administered.
3.Hemodynamic monitoring A 20G arterial catheter
was advanced into the radial artery for continuous
monitoring of systolic arterial pressure, diastolic arterial
pressure and mean arterial pressure(MAP). An 8F triple-
lumen central venous catheter(AG-15854-E; Arrow
International Inc., Reading, PA, USA) was inserted in the
right internal jugular or subclavian veins for measurement
of central venous pressure(CVP). A flexible 4F catheter
with an integrated thermistor(Pulsiocath PV2014L13;
Pulsion Medical Systems, Munich, Germany) was inserted
into the left femoral artery and connected to the stand-
alone monitor PiCCOplus(software version 5.2.2; Pulsion
Medical Systems). Thermodilution measurements of 15
ml iced saline solution(<8℃) injected through the central
venous catheter were performed to determined CO and
stroke volume(SV). Triplicate CO measurements were
averaged from three bolus injections. Global end-diastolic
volume(GEDV) was calculated from CO, mean transit time,
and the down–slope time of the indicator: GEDV = CO
×(mean transit time – down-slope time). Global ejection
fraction(GEF) was obtained from SV and GEDV: GEF =
4×SV/GEDV. The thermodilution was used to calibrate
pulse contour analysis for continuous CO monitoring
and SVV. SVV, as a percentage change of SV during the
Fig. 1 Correlation between SVV and CI, SVI, GEF and
GEDVI in patients in five different body positions.
SVV exhibited a strong and positive correlation with
CI(r2=0.46, P<0.0001), SVI(r2=0.44, P<0.0001), GEF(r2=0.45,
P<0.0001) and GEDVI(r2=0.84, P<0.0001)
Laboratory and ClinicaCl IonvveersTtihgeastiiosn 94 FAM 2015 Mar/Apr Vol.22 Issue 2
ventilatory cycle, was assessed with the following equation:
SVV(%) =(SVmaximum–SVminimum)/SVmean, where
SVmaximum and SVminimum were mean values of
the four extreme values of SV during a 30 s period, and
SVmean was the average value for the time period. CO,
SV, and GEDV were normalized to body surface area into
cardiac index(CI), stroke volume index(SVI) and global
end-diastolic volume index(GEDVI), respectively. The CVP
and MAP were also measured at end-expiration.
4.Statistical Analysis All results are expressed as
the mean ± standard deviation. Statistical analyses
were performed using the SPSS statistical software
package(version 13.0; SPSS Inc, Chicago, IL, USA). The
Analysis of Variance(ANOVA) was used to compare the
hemodynamic variables among the various body positions.
A Pearson correlation was used for linear regression analysis
between SVV and CI, SVI, DEDVI and GEF. The linear
regression analyses of SVV in the supine position with body
position induced changes in CI were also performed with
Pearson correlation. The Pearson correlation coefficients r
and r2 were calculated between two variables. A P value of
less than 0.05 was considered statistically significant.
Results
6 patients were excluded, two of them were diagnosed
as chronic obstructive pulmonary disease, the other
4 patients had blood pressure fluctuation and needed
to adjust the dose of inotropes or vasopressors during
observation.
1.The Pearson correlation of SVV with hemodynamic
Tabel 2.The r, r2 and P value obtained with Pearson
Correlation Analysis between SVV and hemodynamic
data(CI, SVI and GEF) or central blood volume(GEDVI)
CI(l/min/m2) r SVV P
SVI(ml/m2) - 0.68 r2 0.00
- 0.67 0.00
GEF(%) - 0.68 0.46 0.00
GEDVI(ml/m2) -0.84 0.44 0.00
0.46
0.70
SVV, stroke volume variation; CI, cardiac index; SVI, stroke volume
index; GEF, global ejection fraction; GEDVI, global end-diastolic volume
index.