Clinical Study On Volume Responsiveness Of Perioperative Elderly Patients Assessed By Aortic Valve Velocity Time Integral Variation

Objective:Aortic valve velocity time integral variation(△VTI_AO)has good application value in the evaluation of volume responsiveness in critically ill patients,and can be used as a guideline for fluid therapy.To explore the clinical value of aortic valve velocity time integral variation(△VTI_AO)in predicting the volume responsiveness of perioperative elderly patients.Methods:Forty-four elderly patients undergoing elective surgery in our hospital from February 2018 to August 2018 were enrolled.General clinical data of the patients were recorded.After the induction of general anesthesia,blood pressure（BP）,mean arterial pressure（MAP）,heart rate（HR）,aortic valve velocity time integral(VTI_AO)and stroke volume（SV）were recorded before and after volume loading test（VE）as the patients under mechanical ventilation.According to the responsiveness to VE（A positive response was defined as a increase≥15%of the variation of stroke volume measured by LIDCO rapid hemodynamic analyzer）,patients were divided into two groups:responders and non-responders.The observation indexes of the two groups were compared and analyzed.Results:Of 44 patients,25 patients were responders,19 patients were non-responders.Before and after VE,there were significant differences in systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）,aortic valve velocity time integral(VTI_AO)and stroke volume（SV）between the two groups（P<0.05）,but in the non-responders,there was no significant difference in heart rate（HR）.Between the two groups,there were significant differences in the changes in HR,VTI_AO,SV(ΔHR,ΔVTI_AO,ΔSV)（P<0.05 or 0.01）while the changes in SBP,DBP,MBP（ΔSBP,ΔDBP,ΔMBP）showed no significant differences.The Area under the ROC curve（AUC）of VE-inducedΔSV,ΔVTI_AO,ΔMAP andΔHR predicting volume responsiveness in perioperative elderly patients were 1﹝95%CI 1.000-1.000,P=0.000﹞、0.905±0.048﹝95%CI 0.812-0.999,P=0.000﹞、0.558±0.091﹝95%CI 0.379-0.737,P=0.515﹞、0.346±0.085﹝95%CI 0.179-0.514,P=0.084﹞,respectively.TheΔVTI_AO≥15.28%during the VE was found to evaluate the volume responsiveness with a sensitivity of 88%,specificity of 94.7%.In responders group,there was a positive correlation betweenΔVTI_AO andΔSV,Person correlation coefficient of 0.936,P<0.0001.The Kappa test results ofΔVTI_AO andΔSV show that:K=0.773,P<0.05.Conclusion:Aortic valve velocity time integral variation(ΔVTI_AO)has a good predictive value in evaluating volume responsiveness of perioperative elderly patients.