개복 간절제술 환자에서 음향 가변성 지수의 유효성을 평가하기 위한 전향적 탐색 임상시험

Abstract

Background For a patient undergoing major abdominal surgery, fluid management is crucial. The non- invasive, continuous measurement offered by phonographic analysis of heart sound can be useful in diagnosing cardiovascular conditions and fluid responsiveness. By comparing the acoustic variability index (AVI) to established parameters, we evaluated its efficacy as a dynamic indicator and predictor of fluid responsiveness in patients having open abdominal hepatectomy.

Methods Forty patients who required volume expansion during an open abdominal hepatectomy were included. 500 mL of crystalloid were given as part of the fluid challenge protocol over the duration of 10 minutes. Applying an esophageal stethoscope and software that evaluates the systolic time interval (STI) as well as the amplitude of S1 and S2 sounds, AVI was measured. After major surgical procedures, and the subjects became hemodynamically stable, the fluid responsiveness indicators, central venous pressure (CVP), stroke volume variation (SVV), pulse pressure variation (PPV), and AVI were obtained for three minutes before and after fluid loading. Subjects who had a cardiac output increase of at least 10% following volume expansion were classified as responders.

Results Overall, 12 of the 37 patients were responders. The baseline hemodynamic variables of the responders and non-responders, that include stroke volume (SV), SVV, PPV, and AVI, demonstrated significant differences. After fluid loading, responders showed significant decreases in AVI (11.4 ± 2.3 % vs. 7.8 ± 2.8 %, P < 0.01), whereas AVI in non-responders remained unchanged (7.1 ± 3.1 % vs. 6.3 ± 2.9 %, P = 0.356). Fluid responsiveness could be predicted provided the cut-off value was greater than 9.8% AVI from the baseline with an area under the receiver operating characteristic curve of 0.873 (95% confidence interval, 0.722 – 0.959).

Conclusions Intra-operative AVI can predict fluid responsiveness in patients undergoing open abdominal hepatectomy. AVI may be continuously and real-time monitored for fluid management as a useful non- invasive hemodynamic index.