无创超声心输出量监测技术联合被动抬腿试验评估心脏术后患者容量反应性的作用  

Non- invasive USCOM and passive leg raising test in evaluation of volume responsiveness in cardiac surgery patients

作　　者：郑俊波[1] 叶明[1] 于凯江[1] 王洪亮[1] 贾柳[1] 

机构地区：[1]哈尔滨医科大学附属第二医院ICU,黑龙江哈尔滨150086

出　　处：《中国急救医学》2012年第5期416-420,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨无创超声心输出量监测技术（USCOM）联合被动抬腿试验（PLR）评估心脏术后患者容量反应性的作用.方法 2010-02～2010-06心脏瓣膜置换术后需要扩容的患者纳入本研究,按四个阶段进行：半卧位;躯体仰卧位,下肢抬高45°进行PLR;回到半卧位;30 min内静脉输注500 mL 6%羟乙基淀粉进行扩容.通过USCOM连续进行心输出量（CO）和每搏输出量（SV）监测.根据扩容后SV的变化值（ΔSV）是否 ≥15% 分为反应组和无反应组.受试者工作特征曲线评价PLR所致ΔSV预测容量反应性的价值.结果 80例需要扩容的患者纳入本研究,9例因不能得到满意的USCOM多普勒信号被排除,32例（45.1%）患者ΔSV≥15%为反应组.PLR所致ΔSV曲线下面积（AUC）是0.84±0.05,ΔSV≥15%预测容量反应性的敏感度和特异度分别为56%和100%,阳性预测值和阴性预测者分别是65%和100%.结论 通过USCOM监测PLR所致ΔSV对评估心脏术后患者容量反应性具有一定的指导意义.Objective To assess the ability of non - invasive （USCOM） technique combined with passive leg raising （PLR） to predict volume responsiveness in cardiac surgery patients. Methods From February 2010 to June 2010, postoperative cardiac valve replacement patients requiring capacity expansion were eligible for enrollment and were studied in four phases： semirecumbent position, PLR at 45° with the trunk lowered in a supine position, back in the semirecumbent position, and capacity expansion by infusing 500 mL of 6% hydroxyethyl starch. Non - invasive measurements of stroke volume （SV） and cardiac output （CO） were continuously assessed by using USCOM device. Patients with an increase of SV 1〉 15% and SV 〈 15% induced by capacity expansion were classified as responders and non- responders respectively. Results Eighty cardiac surgery patients need capacity expansion were included. Nine patients were excluded because it was not possible to obtain satisfactory Doppler signals. In response to the fluid infusion, 32（45.1% ） patients were responders with an increase of SV ≥ 15%. By using receiver operating characteristic analysis, the area under the curve was 0.84 ＋ 0. 05 for ASV induced by PLR. An increase in SV≥ 15% during PLR predicted volume responsiveness with a sensitivity of 56% and a specificity of 100% , positive predictive value of 65% and negative predictive value of 100%. Conclusion PLR - induced changes in SV measured non - invasively by USCOM may be helpful to predict fluid responsiveness in patients following cardiac surgery.

关 键 词：超声检查 被动抬腿试验 容量反应性 每搏输出量 心脏手术 

分 类 号：R542.5[医药卫生—心血管疾病]