자발 호흡을 유지하는 정상 성인에서 수동적 하지 거상법 시행 후 혈역학적 변화와 맥박 산소 측정기를 이용한 혈량 파형의 진폭 변이도 조사

Background: In hemodynamically unstable patients with spontaneous breathing activity, predicting volume responsivenss is a difficult challenge. Our objective was to test whether the respiratory changes in pulse oxymetry plethysmographic waveform amplitude (POP) and in stroke volume (ΔSV) could predict fluid responsiveness to passive leg raising (PLR) in normal volunteers. Methods: We investigated 25 normal volunteers. We assessed hemodynamic status (HR, SBP, MAP, CI and SVI) and calculated the respiratory variation in pulse oximetry plethysmographic waveform amplitude at supine and after PLR. We attached a pulse oximeter of 25 spontaneously breathing volunteers as several time points: after 1 min and 5 min in supine position and during PLR at 60o. Heart rate, non-invasive blood pressures (mean arterial pressure, systolic blood pressure), maximal POP (POPmax), minimal POP (POPmin) and ΔPOP defined as (POPmax−POPmin)/[(POPmax＋POPmin)/2] were recorded using monitor. Results: Comparing to supine and PLR, systolic blood pressure and mean arterial pressure were not different, but the change in cardiac index, stroke volume and respiratory variation in POP were significant different. In response group (≥10% in ΔCI), the change in cardiac index, stroke volume and respiratory variation in POP were significant greater. Conclusions: PLR induces a significant decrement of variation in POP amplitude among spontaneouely breathing volunteers. We suppose that the changes in stroke volume and the respiratory variation in pulse oximetry plethysmographic waveform amplitude induced by PLR predict fluid responsiveness in spontaneous breathing patients.