Research On Responsiveness And Sensitivity Of Artificial Pneumoperitoneum On Volume Treatment In Patients Undergoing Laparoscopic Surgery

Objective: This paper probes into the effect of artificial pneumoperitoneum on stroke volume variation in patients undergoing laparoscopic surgery with volume load, to assess responsiveness and sensitivity of stroke volume variation under this circumstance and then to provide theoretical basis for conducting volume treatment in patients undergoing laparoscopic surgery.Methods: Twenty patients scheduled to undergo laparoscopic gastrointestinal surgery were enrolled, aged 18 to 85 years, ASAⅠ orⅡ. All patients had general anesthesia with volume control ventilation, tidal volume(TV) 10ml/kg, respiratory rate(RR)10-14 times/min. Routine monitoring includes heart rate(HR), blood pressure(BP), electrocardiogram(ECG), pulse oximetry(Sp O2), bispectral index(BIS), the right internal jugular vein catheterization, monitoring of central venous pressure(CVP); Left radial artery catheterization is linked with Flo Trac sensor and accessed to Vigileo flow pressure monitor, monitoring cardiac output(CO), cardiac index(CI), stroke volume(SV), stroke volume index(SVI), stroke volume variation(SVV) and other hemodynamic parameters. Volume-load test was conducted 5 minutes after the artificial pneumoperitoneum with 4% succinylated gelatin of 7ml/kg within 10-15 min. HR、CVP、MAP、CO、CI、SV、SVI and SVV were measured at three time points: after intubation, before infusion, and after infusion.Fluid responsiveness was defined as an increase in SVI ≥ 10 %( Δ SVI ≥10).Patients were divided into two groups: responders and non-responders. The data was recorded respectively, and then the ROC curves were drawn to determine sensitivity of stroke volume on volume treatment with artificial pneumoperitoneum.Results: The SVV and CVP of 12 cases among responders increased(respectively, increased from 10.3±1.3% to 14.8±1.0%; from8.3±0.8cm H2 O to 10.7±1.5cm H2O; P<0.05) in mechanically ventilated patients under general anesthesia before and after artificial pneumoperitoneum; the SVV and CVP of 8 cases among non-responders increased(respectively, increased from 11.4±1.1% to 13.3±1.3%; from 9.3±1.0cm H2 O to 10.4±0.5cm H2O; P<0.05). Before and after volume load, SVV of 12 cases among responders decreased significantly(from 14.8±1.0% to10.9±1.0%,P<0.05),while there was no significant change in CVP(P>0.05); the SVV and CVP of 8 cases among non-responders, however, had no obvious change(P>0.05). ROC curves showed the AUC of SVV to predict responsiveness of volume treatment were 0.885, a threshold SVV value of 9.0%,discriminated between responders and non-responders to volume expansion responsiveness, with a sensitivity of 100% and a specificity of 87.5%,P=0.004. Conclusion: The analysis of ROC curves showed that SVV were able to monitor volume status accurately in mechanically ventilated patients under general anesthesia with artificial pneumoperitoneum.