Clinical Observation Of Stroke Volume Variation Measured By Vigileo/FloTrac In Assessing Fluid Responsiveness Of Diabetic Patients

BackgroundDue to autonomic neuropathy and cardiovascular damage,diabetic patients have progressively reduced their cardiovascular self-regulation ability,and then after being affected by factors such as anesthesia,surgery,stress,etc.,their compensatory ability and balance ability are restricted and prone to appear large fluctuations in circulation.This is also an important reason why diabetes patients are prone to cardiovascular accidents during the perioperative period.Therefore,in addition to the management of blood sugar during the perioperative period,diabetic patients should also pay attention to the management of circulatory stability.Effective volume therapy is the basis to ensure tissue perfusion and maintain circulatory filling,and fluid responsiveness assessment is the prerequisite for volume therapy.Functional hemodynamic indicators such as stroke volume variability(SVV)are reliable indicators of fluid responsiveness[1-3].Previous studies have shown that SVV measured by the Vigileo/FloTrac system can accurately predict fluid responsiveness in mechanically ventilated patients.So far,the accuracy of the Vigileo/FloTrac system has been extensively studied in more than 70 verification experiments[4].The system is a device that uses the arterial pressure waveform to measure cadiac output.Any factors that affect heart rate and arterial waveform will have an impact on the monitoring results.According to previous studies,we know that systemic vascular resistance is one of the factors that affect the accuracy of the Vigileo/FloTrac system[5].Due to autonomic neuropathy,diabetic patients are vulnerable to the effects of anesthetic drugs on their systemic vascular resistance.The pathophysiological changes of autonomic neuropathy and cardiovascular injury in diabetic patients often become factors that researchers consider to affect the accuracy of the system.When verifying whether SVV can reflect the patient's volume responsiveness,diabetic patients are used as exclusion criteria[6],and so far no evaluation of the significance of SVV in diabetic patients.Therefore,the main purpose of this study is to evaluate whether SVV measured by the Vigileo/FloTrac system can reflect the volume responsiveness of diabetic patients,and to compare SVV with other common hemodynamic indicators.MethodsThirty-eight diabetic patients underwent elective general anesthesia mechanical ventilation with non-cardiac surgery were enrolled in hour hospital.SVV,SV and other hemodynamic indicators were continuously displayded by the Vigileo/Flotrac system.All patients used rapid sequential induction and volume control ventilation mode.Recorded stroke volume immediately before and after the fluid challenging test(250ml hydroxyethyl starch),calculate Stroke volume change induced by volume expansion(?SV)?10%as a standard for fluid responsiveness.By drawing the operating characteristic(ROC)curve of SVV,it can be judged whether SVV can be used as a predictor for flud responsiveness of diabetic patients,and calculate the diagnosis threshold of SVV,analyze its sensitivity and specificity.The correlation between ?SV and hemodynamic variables were obtained through Pearson correlation analysis.ResultsThirty-eight patients with general anesthesia and mechanical ventilation with elective non-cardiac surgery were selected in our hospital,of which 25(65.8%)were positive for volume response and 13(34.2%)were negative for volume response.The SVV in the positive volume response group was significantly higher than that in the negative volume response group(17±6 vs.9±3,P=0.005).The area under the curve obtained by drawing the ROC curve of SVV is 0.871(95%CI:0.761 to 0.981),P<0.001.When the SVV is 10.5%to determine whether the fluid has a response or not,the sensitivity is 88%,the specificity is 69.2%.The baseline SVV before fluid challenge(r=0.556,P<0.001)and percentage change(?)in SVV(r=0.473,P=0.003)correlated significantly to ?SVConclusionsSVV measured by Vigileo/Flotrac can accurately predict fluid responsiveness in diabetic patients undergoing mechanical ventilation general anesthesia.When SVV ?10.5%,250ml liquid can increase stroke volume by at least 10%,and its sensitivity is 88%,the specificity is 69.2%.