The Clinical Research Ofultrasound-measured Variation Of Internal Jugular Vein Respiration In Fluid Responsiveness Assessment On Patients Receiving Radical Gastrectomy For Gastric Cancer

Object To evaluate the value of ultrasound-measured variation of internal jugular vein respiration in fluid responsiveness assessment on patients receiving radical gastrectomy for gastric cancer.Objective to provide a reference for fluid administration in the clinical.Methods Fifty patients,aged 40-64 yr.of ASA physical status Ⅰ or Ⅱ.scheduled for selective radical gastrectomv for gastric cancer.All patients had no arrhythmia.cardiac insufficiency,no contraindications of arterial puncture and internal jugular vein puncture.normal coagulation indexes,clear internal jugular vein imaging by ultrasonography and so on.All patients were routinely banned from eating for 8 hours.and the upper limb venous access was opened after entering the room.ECG(ECG).heart rate(HR),pulse oxygen saturation(SPO2)and noninvasive blood pressure(NIBP)were measured routinely after stable circulation.Radial artery puncture manometr\and internal jugular vein puncture manometry under local anesthesia were recorded and recorded the hemodynamic parameters such as heart rate(HR).central venous pressure(CVP).cardiac index(CI).stroke volume index(SVI),stroke volume variation(SVV).Then the anesthesia was induced by intravenous administration,and all the patients were treated with the same preoperative drugs,narcotic drugs and monitoring methods.the same group of anesthesiologists completed the perioperative anesthesia operation and treatment.After endotracheal intubation 5 min,HR.CVP,CI.SVI.SVV were recorded.The head of the patient was raised by 20 °to make the patient in semi-supine position.The maximum value of inspiratorv phase and the minimum value of expiratory phase of the diameter of internal jugular vein were measured by ultrasound.The respiratory variabiliry of internal jugular vein(variation of internal jugular vein respiration.VIJVR)was calculated and recorded by formula.the formula of VIJVR was VIJVR=[(DIJV max-DIJV min)/DIJV min]× 100%.After that,the patient was restored to supine position,and the volume load test was performed.After the patient’s circuiation was stable.volume expansion was earried out.Hydroxyethyl starch 130/0.4 6 ml/kg was infused over 15 min.HR.CVP.CI.SVI,SVV were recorded within 5 min after volume expansion.After that,the head of the patient was raised 20 °again.the VIJVR was measured and recorded by ultrasound.and then the patient was restored to supine position.Patient were classified as responders(△SVI≥15%)and non-responders(ΔSVI<15%)after volume expansion.The formula is SVI=[(SVV a(?)er rehydration-SVV before rehvdration)SVV before rehydration]× 100%.The ROC curve was drawn according to the ROC curve.the diagnostic threshold,sensitivity.specificity,area under the curve and 95%confidence interval of VIJVR were determined.Results Compared with the value before administration of the loading dose.the CVP、CI and SVI were significantly increased.VIJVR、SVV were decreased after volume expansion in responders group(P<0.05).Before and after the volume expansion,the index were not statistically different in non-responders group(P>0.OS).There are no statistically significant between two groups before administration of the loading dose.Compared with the responders group.VIJVR and SVV were significantly increased before volume expansion,SVI and CI were significantly increased before volume expansion(P<0.05).After volume expansion,CVP were significantly greater than non-responders group and VIJVR were less than responders group(P<0.05).The areas under receiver operating characteristic curve(AUC)of CVP to predict volume responsiveness was 0.402(95%CI:0.218～0.587),when the cut-off value of CVP was 7.5 cmH2O for predicting volume responsiveness,the sensitivity was 94.6%and the specificity was 7.3%.The areas under receiver operating characteristic curve(AUC)of SVV to predict volume responsiveness was 0.861(95%CI0.717-1.000),when the cut-off value of SVV was 10.50%for predicting volume responsiveness,the sensitivity was 89.2%and the specificity was 76.9%.The areas under receiver operating characteristic curve(AUC)of VIJVR to predict volume responsiveness was 0.852(95%CI 0.744-0.961),when the cut-off value of VIJVR was 24.6%for predicting volume responsiveness,the sensitivity was 67.6%and the specificity was 92.3%.Conclusion Variation of internal jugular vein respiration measured by ultrasound can effectively assess the fluid responsiveness in patients receiving radical gastrectomy for gastric cancer.It can be a noninvasive index to direct fluid treatment.