Page 14 - 麻醉与监护论坛2015年第4期

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data The variables for Pearson correlation were obtained 3.The influence of the 30° right and 30° left recumbent
from the ventilated patients with five body positions, not position on the hemodynamic data, central blood volume
in a specific position. The SVV exhibited a significant and SVV The hemodynamic data in the 30° left or right
and negative correlation with CI(r=-0.68, P<0.0001), recumbent position are summarized in Table 3. The 30°
SVI(r=-0.67, P<0.0001), GEF(r=-0.68, P<0.0001) and right or left recumbent positions did not change the MAP,
GEDVI(r=-0.84, P<0.0001)(Figure 1). These data suggested CI, SVI and GEF in the volume controlled ventilation
that the body position changes did not impact the models. Concomitantly, GEDVI did not differ between the
correlation relationship between SVV and hemodynamic supine position and either the 30° right recumbent position
data. or the 30° left recumbent position. More importantly, the
SVV of the 30° right and left recumbent positions were
The Pearson correlation results comparing SVV comparable to the supine position(Figure 2b, 2c). These
with the hemodynamic data are summarized in Table 2. data suggest that 30° left and 30° right recumbent position
The r values between SVV and hemodynamic variables did not affect SVV without any resulting changes in
ranged from -0.68 to -0.84. The r2 between SVV and hemodynamic conditions.
hemodynamic variables suggested that 44% -70% of
output or preload changes could be accounted for by 4.The Pearson correlation of SVV in the supine
changes in SVV. These data suggest that SVV was reliable position with 30° head-up or prone position induced
for functional hemodynamic monitoring in ventilated changes in CI The SVV in the supine position did not
patients with sepsis. correlate with the 30° head-up position induced changes in
CI(r =-0.119, P>0.05) or prone position induced changes
2.The influence of the 30° head-up and prone position in CI(r -0.130, P> 0.05)(Figure 3). The r2 values for SVV
on the hemodynamic data and SVV The 30° head-up compared with changes in CI were 1.4% and 1.7% after
position induced a significantly reduction in MAP, CI, SVI 30° head-up and prone position, respectively(Table 4).
and GEF in the volume controlled ventilation models(Table These suggested that alteration of CI and SVV induced by
3). Concomitantly, GEDVI was also decreased with the body position changes were not only preload-dependent.
30° head-up position. More importantly, the SVV was The other mechanisms, except for decreased central blood
elevated from 8.1±3.5% to 10.5±4.2% by 30° head-up volume, might be responsible for the alterations on SVV
position(Figure 2a). The prone position significantly and CI induced by body position changes.
reduced MAP, CI, SVI and GEF. Concomitantly, GEDVI
was also reduced after prone position. More importantly, Discussion
SVV of the prone position(12.6±5.5%) was markedly
higher than that of the supine position(8.1±3.5%)(Figure The usefulness of SVV to predict the fluid
2d). These suggested that the 30° head-up and prone responsiveness has been demonstrated in ventilated and
positions reduced the stroke volume, increased the SVV, supine patients with shock[11-13]. However, ventilated patients
and were associated with hemodynamic depression. may require body position changes such as the head-up,
left or right recumbent and prone position for the purpose

Tabel 3.Hemodynamic data in patients undergoing mechanical ventilation on the five various body positions

Items Supine 30° Head-up Prone 30°Left Recumbent 30°Right Recumbent
MAP(mmHg) 82.6 ±10.2 75.4 ±9.5(1) 70.1 ±8.5(1) 83.8 ±11.6 81 ±12.3
CI(l/min/m2) 2.1 ± 0.7* 2.2 ±0.4(1) 3.1 ±0.4 3.5 ±0.3
SVI(ml/m2) 3.2 ±0.6 30.2 ± 4.4(1) 28.8 ± 4(1) 35.7 ±6.2 36.9 ± 5.1
36.8 ± 5.6 25.4 ±4.1(1) 24.2 ± 6.2(1) 29.8 ± 6.5 29.6 ± 5.5
GEF(%) 28.5 ± 5.4 681.1±12.6(1) 676.5 ± 14.5(1) 692.5 ±18.4
GEDVI(ml/m2) 702.2 ±15.8 706.3 ±16.7

MAP, mean arterial pressure; CI, cardiac index; SVI, stroke volume index; GEF, global ejection fraction; GEDVI, global end diastolic volume index.
(1) P<0.05 versus supine

Laboratory and ClinicalCIonverstTighaetsiiosn 95 FAM 2015 Mar/Apr Vol.22 Issue 2