肱动脉峰流速结合被动抬腿试验判断容量反应性  

Predication of volume responsiveness by brachial artery velocity change during passive leg raising

作　　者：张宏民[1] 刘大为[1] 王小亭[1] 张青[1] 刘晔[1] 隆云[1] 柴文昭[1] 周翔[1] 芮曦[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院重症医学科,100730

出　　处：《中华医学杂志》2013年第3期195-199,共5页National Medical Journal of China

摘　　要：目的评价肱动脉峰流速（Vpeak—BA）结合被动抬腿试验（PLR）能否作为判断存在自主呼吸的重症患者容量反应性的指标。方法前瞻性分析收住重症医学科机械通气且存在自主呼吸的患者，通过超声检查，比较PLR前后Vpeak-BA的变化（AVBA-PLR）和容量负荷试验前后左室流出道速度-时间积分的变化（AVTI—VE），并绘制受试者工作特征曲线（ROC）确定AVBA—PLR判断容量反应性的敏感度和特异度。结果共有29例患者入选本研究，15例容量负荷试验有反应（有反应组），14例容量负荷试验无反应（无反应组）。AVBA-PLR与AVTI—VE具有相关性（R2=0．378，P=0．011）。以AVBA-PLR≥16％评价存在自主呼吸重症患者容量反应性，灵敏度为73％，特异度87％。结论肱动脉峰流速结合被动抬腿试验可以作为判断存在自主呼吸的重症患者容量反应性的指标。Objective To evaluate whether or not brachial artery peak velocity （Vpeak-BA） induced by passive leg raising （PLR） may predict volume responsiveness. Methods We prospectively studied 29 patients enrolled into our intensive care unit （ICU） with spontaneous breathing during mechanical ventilation. Through echocardiography we compared the changes of brachial artery peak velocity induced by passive leg raising （AVBA-PLR） and the changes of left ventricle outflow tract velocity-time integral after volume expansion （AVTI-VE）. Also the sensitivity and specificity of AVpeak-BA were determined in predicting volume responsiveness. Results Among them, 15 responded to volume expansion and the rest 14 did not. AVBA-PLR and AVTI-VE were mutually correlated （ R2 = 0. 378, P = 0. 011 ）. The sensitivity and specificity of AVpeak-BA ≥ 16% to predict volume responsiveness were 73% and 87% respectively. Conclusion Brachial artery peak velocity induced by passive leg raising is a reliable indicator of predicting volume responsiveness in patients with spontaneous breathing.

关 键 词：肱动脉 血流速度 肺容量测定 

分 类 号：R563.8[医药卫生—呼吸系统]