每搏量变异度预测严重感染和感染性休克患者容量反应性的价值  

The role of stroke volume variation in predicting the volume responsiveness of patients with severe sepsis and septic shock

作　　者：黄磊[1] 张卫星[1] 蔡文训[1] 罗华[1] 陈映群[1] 张声[1] 

机构地区：[1]北京大学深圳医院ICU,广东省深圳518036

出　　处：《中华急诊医学杂志》2010年第9期916-920,共5页Chinese Journal of Emergency Medicine

基　　金：深圳市科技计划资助项目（200902068）

摘　　要：目的 研究每搏量变异度（stroke volume variation,SW）预测严重感染和感染性休克机械通气患者容量反应性的价值.方法 前瞻观察性研究,对2009年1月至2010年3月北京大学深圳医院ICU严重感染和感染性休克机械通气患者28例进行容量负荷试验.超声心输出量监测仪无创监测心脏指数（cardiac index,CI）、每搏输出量指数（stroke volume index,SVI）、外周血管阻力（systemic vascular resistance,SVR）、SVV等血流动力学指标.根据容量负荷试验前后CI增加值是否大于12%分为有反应组和无反应组,组间比较应用两独立样本t检验;容量负荷试验前后比较应用配对t检验;受试者工作特征曲线评价SVV、中心静脉压（central venous pressure,CVP）以及容量负荷试验前后CVP变化值（△CVP）预测容量反应性的价值.结果 容量负荷试验前,有反应组SW高于无反应组[（18.2±4.7）%和（12.7±4.2）%,P=0.003];而CVP两组差异无统计学意义[（10.2±4.0）cmH2O和（10.8±4.8）cmH2O,P＞0.05].容量负荷试验后,有反应组△CVP低于无反应组[（2.9±3.1）cmH2O和（5.3±2.7）cmH2O,P=0.037].SVV、CVP和△CVP的曲线下面积（AUC）分别是0.836（95%CI：0.680～0.992,P=0.003）、0.549（95%CI：0.329～0.768,P=0.662）和0.762（95%CI：0.570～0.953,P=0.019）.SVV为15.5%时预测容量反应性的敏感度和特异度分别是84.6%和80%.结论 SVV预测严重感染和感染性休克机械通气患者的容量反应性具有良好价值,明显优于CVP、△CVP等传统指标.Objective To assess the role of stroke volume variation （SVV） in predicting the volume responsiveness of mechanically ventilated patients with severe sepsis and septic shock. Method A total of 28 mechanically ventilated patients with severe sepsis and septic shock were admitted from January 2009 to March 2010. Every patient was treated with volume loading test. Cardiac index （CI）, stroke volume index （SVI）, systemic vascular resistance （SVR） and SVV were measured non-invasively by Ultrasonic Cardiac Output Monitor （USCOM） device.Patients with an increase in CI ＞ 12% and ＜ 12% after volume loading test were classified as responders and nonresponders, respectively. The comparisons between these two sorts of patients were assessed by using two sample Student＇ s t -test, and comparisons between changes before and after volume loading test were assessed by using a paired Student＇s t -test. The roles of SVV, central venous pressure （CVP） and the changes of CVP （△CVP） after fluid administration in predicting volume responsiveness were evaluated by receiver operating characteristic （ROC） curves. Results Before volume loading test, the SVV was higher in responders in comparison with non-responders [（18.2 ± 4.7）% vs. （12.7 ± 4.2）%, P = 0.003] and the CVP was not significantly different between two groups [（10.2±4.0） cmH2O vs. （10.8±4.8） cmH2O, P ＞0.05]. After volume loading test,the CVP was lower in responders [（2.9 ± 3.1 ） cmH2O vs. （5.3 ± 2.7） cmH2O, P = 0.003]. The areas under the ROC curves （AUC） were 0.836 （95% CI：0.680 ～ 0.992,P = 0.003）,0.549 （95% CI：0.329 ～ 0.768,P = 0.662）and 0.762 （95% CI：0.570 ～ 0.953,P = 0.019）for SVV, CVP and △CVP, respectively. The 15.5% of SVV value had the 84.6% of sensitivity and 80% of specificity for prediction of volume responsiveness. Conclusions SVV can serve as a valid indicator of predicting volume responsiveness in mechanically ventilated patients with severe sepsis and septic sh

关 键 词：每搏量变异度 严重感染和感染性休克 容量反应性 中心静脉压 容量负荷试验 血流动力学 机械通气 心脏指数 

分 类 号：R459.7[医药卫生—急诊医学]