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目的探讨每搏输出量变异度(SVV)和胸腔内血容量指数(ITBI)在失血性休克犬容量状态评价中的意义。方法以改良Wiggers’法复制失血性休克犬模型,Swan-Ganz导管和PiCCO仪监测血流动力学,重复行容量负荷试验,根据每搏输出量的变化(ΔSV)是否大于5％分为反应组和无反应组。结果14只犬共行容量负荷试验134次,反应组94次,无反应组40次。容量负荷试验后反应组心率(HR)、平均动脉压(MAP)、SVV和ITBI的变化明显大于无反应组。反应组中心静脉压(CVP)和肺动脉楔压(PAWP)的变化明显小于无反应组。ITBI、SVV与ΔSV显著相关,HR、MAP、CVP、PAWP与ΔSV无明显相关。容量负荷试验后ΔCVP、ΔPAWP、ΔITBI、ΔSVV与ΔSV显著相关,而ΔHR、ΔMAP与ΔSV无明显相关。受试犬操作特征(ROC)曲线:SVV的曲线下面积(AUC)为0．872, ITBI的AUC为0．689,明显高于HR、MAP、CVP和PAWP(0．294～0．593)。SVV大于9．5％对容量负荷试验有反应的敏感性为92．6％,特异性为82．5％。结论SVV和ITBI对容量状态的评价明显优于CVP和PAWP。SVV持续监测有助于容量状态评价和液体管理。
Objective To investigate the significance of stroke volume variability (SVV) and intrathoracic blood volume index (ITBI) in the assessment of hemorrhagic shock capacity in dogs. Methods Hemodynamic and repeated volumetric load tests were performed in Wiggers’ hemorrhagic shock model, Swan-Ganz catheter and PiCCO instrument. According to whether the change of stroke volume (ΔSV) was more than 5% And no reaction group. Results A total of 14 dogs were subjected to a capacity load test of 134 times, with 94 reaction groups and 40 non-reaction groups. The changes of heart rate (HR), mean arterial pressure (MAP), SVV and ITBI in the response group after the volume load test were significantly greater than those in the non-reaction group. The changes of central venous pressure (CVP) and pulmonary arterial wedge pressure (PAWP) in response group were significantly lower than those in non-responsive group. ITBI, SVV and ΔSV were significantly correlated, HR, MAP, CVP, PAWP and ΔSV no significant correlation. ΔCVP, ΔPAWP, ΔITBI, ΔSVV and ΔSV were significantly correlated with ΔSV after capacity loading test, while ΔHR, ΔMAP had no significant correlation with ΔSV. The ROC curve showed that the area under the curve (AUC) of SVV was 0.872 and the AUC of ITBI was 0.689, which was significantly higher than that of HR, MAP, CVP and PAWP (0.294-0.593) . An SVV greater than 9.5% had a sensitivity of 92.6% and a specificity of 82.5% for capacity stress tests. Conclusions SVV and ITBI are superior to CVP and PAWP in evaluating the state of volume. Continuous monitoring of SVV contributes to capacity status assessment and liquid management.