超声心排出量检测仪预测脓毒性休克患儿容量反应性的价值  

Ultrasonic cardiac output monitor for predicting volume responsiveness in children with septic shock

作　　者：武宇辉[1] 何颜霞[1] 杨卫国[1] 刘晓红[1] 杨燕澜[1] 夏宇[1] 马伟科[1] 曾细秋[1] 

机构地区：[1]重庆医科大学附属深圳市儿童医院PICU,深圳518026

出　　处：《中华实用儿科临床杂志》2013年第6期429-431,共3页Chinese Journal of Applied Clinical Pediatrics

基　　金：深圳市医学重点学科专项资金（深卫人医政[2011]107号）;深圳市科技计划项目（医疗卫生类）（200602081）

摘　　要：目的研究超声心排出量检测仪（USCOM）预测脓毒性休克患儿容量反应性的价值。方法采用前瞻性、观察性队列研究设计方法，选择21例需机械通气的脓毒性休克患儿进行容量负荷试验。在每个试验前后采用USCOM测定每搏输出量（SV）、每搏输出量指数（SVI）、心脏指数（cI）、外周血管阻力指数（SVRI）、每搏变异度（SVV）等血流动力学指标。根据容量负荷试验前后SV的变化（以容量负荷试验后SV增加≥10％为有反应）将患儿分为有反应组和无反应组。采用t检验或x^2检验，受试者工作特征曲线（ROC曲线）评价容量负荷试验前SVV、中心静脉压（CVP）预测容量反应性的价值。结果21例患儿共行容量负荷试验23例次，有反应组13例次，无反应组10例次。容量负荷试验前，有反应组SVV高于无反应组（P=0．003）；而2组CVP比较差异无统计学意义（P〉0．05）。SVV预测容量反应性的ROC曲线下面积（AUC）为92．4％（95％CI：0．821—1．000，P=0．001），SVV〉17．5％时预测容量反应性的敏感度为75．0％，特异度为81．8％。CVP预测容量反应性的AUC为45．8％（95％酣：0．206～0．710，P=0．742），CVP〈5．5emH20（1emH20=0．098kPa）预测容量反应性的敏感度为41．7％，特异度为60．0％。结论用USCOM测定SVV可反映脓毒性休克机械通气患儿液体治疗时的容量反应性，明显优于CVP等传统指标，可用以指导患儿的液体治疗。Objective To assess the role of ultrasonic cardiac output monitor （USCOM） in predicting the volume responsiveness of children with septic shock. Methods The study was performed with prospective, observational cohort study method. Twenty-one mechanically ventilated children with septic shock were included. All children were treated with volume expansion （VE） test. Hemodynamic indicators such as stroke volume （SV）, stroke volume index （SVI）,cardiac index （CI） ,stroke volume index （SVI） ,systemic vascular resistance index （SVRI） and stroke volume variation （SVV） were measured by USCOM before and after each test. Based on the responsiveness of VE （children were considered to be responders to VE if SV increased~〉 10% ） ,the sick children were divided into re- sponsive group and non-responsive group, respectively. The comparisons between these 2 sorts of children were assessed by using t-test or X2 test. The roles of SVV, central venous pressure （CVP） before fluid administration in predicting vo- lume responsiveness were evaluated by receiver operating characteristic curve （ROC）. Results A total of 23 VE tests in 21 patients were evaluated and 13 responders and l0 non-responders were identified. There was no significant diffe- rence in the clinical data at incipient stage between 2 groups. Before VE test, the SVV was higher in responders in com- parison with non-responders （ P = 0.003 ） , and the CVP was not significantly different between the 2 groups （ P 〉 0.05 ）. The area under the ROC curve （AUC） of SVV to predict volume responsiveness was 92.4% [95% confidence interval （95% CI） ： 0. 821 - 1. 000, P = 0. 001 ], the SVV 〉 17.5% showed 75.0% of sensitivity and 81.8% of specificity for predicting volume responsiveness. The AUC of CVP to predict volume responsiveness was 92.4% （95% CI： 0. 206 -0. 710, P = 0. 742）, the CVP 〈 5.5 cm H2 O（ 1 cm H20 = 0. 098 kPa） was predictive of response to VE with a sensitivity of 41.7% and a specificity of

关 键 词：超声心排出量检测仪 容量负荷试验 每搏变异度 脓毒性休克 

分 类 号：R459.7[医药卫生—急诊医学]