SVV和PPV预测ARDS患者液体反应的价值研究  

Clinical Application of SVV and PPV to Predict Volume Responce in Acute Respiratory Distress Syndrome Patients

作　　者：朱英[1] 刘长文[1] 胡炜[1] 朱克毅[1] 陆骏[1] 胡伟航[1] 郑永科[1] 刘炳炜[1] 王剑荣[1] 

机构地区：[1]杭州市第一人民医院ICU,310006

出　　处：《医学研究杂志》2013年第5期99-102,共4页Journal of Medical Research

基　　金：浙江省医药卫生科学研究基金资助项目(2009B128)

摘　　要：目的心肺交互作用指标SVV、PPV能较好地预测机械通气患者液体反应,但其预测效能可能受潮气量和PEEP水平的影响,本研究旨在评价SVV、PPV预测ARDS(实施小潮气量+PEEP的保护性通气策略)患者液体反应的价值。方法将2009年7月～2011年1月期间入住笔者所在科室的11例ARDS患者纳入研究,PiCCO进行动态血流动力学监测,记录基础SVV、PPV、心排出量指数(CI)、血管外肺水指数(ELWI)、氧输送指数(DO2I)等数据后进行容量负荷试验:6%羟乙基淀粉250ml在30min内匀速静脉输注后,若心排出量增加(△CI)<15%(无反应),则结束试验;若△CI≥15%(有反应),则再进行一次容量负荷试验后结束试验(作为两人次试验),每次容量负荷试验后均收集上述数据。按△CI将患者分为有反应组和无反应组,再根据PEEP水平将患者分为PEEP<10cmH2O和PEEP>10cmH2O两个亚组,分析各变量的变化。结果有反应组和无反应组补液前基础SVV、PPV无显著差异(11.4±5.1 vs 14.2±5.9,P>0.05)、(11.0±5.0 vs 9.4±4.6,P>0.05);低PEEP组有反应患者和无反应患者补液前基础SVV、PPV无显著差异(9.8±3.8 vs 16.5±6.4,P>0.05)、(9.9±2.7 vs 12.1±3.8,P>0.05);高PEEP组有反应患者和无反应患者补液前基础SVV、PPV也无显著差异(14.0±6.8 vs 11.4±4.1,P>0.05)、(13.0±8.0 vs 6.2±3.6,P>0.05)。补液后,有反应组CI显著增加(5.3±0.2 vs 4.5±0.3,P<0.05),无反应组CI显著减少(4.3±0.4 vs 4.6±0.4,P<0.05)、DO2I显著减少(416±35 vs 463±31,P<0.05),补液前后两组ELWI、PaO2/FiO2均无明显变化。结论 SVV、PPV不能预测实施肺保护性通气的ARDS的液体反应。Objective Stroke volume variation（SVV） and pulse pressure variation（PPV） have been reported to excellently predict fluid responsiveness in ventilated patients, but the validity is unknown in patients with acute respiratory distress syndrome（ARDS） , who was ventilated with low tidal volume and high peep according to current guidelines. Methods Eleven ARDS patients were enrolled. SVV, PPV, cardiac output index（CI） , extravascular lung water index（ELWI） , oxygen delivery index（ DO2I） were obtained from a PiCCOplus monitor. The whole set of hemodynamic measurements was performed before and after fluid challenge with 250ml hydroxyethyl starch. Fluid challenge was given again if the increased cardiac output ≥ 15% （responder）. Results There was no significant difference in SVV and PPV between responders and noresponders even in subgroups according peep. CI increased significantly after fluid challenge （ 4.5 ± 0.3 vs 5.3 ± 0.2, P 〈 0.05 ） in responders and decreased （4.6 ± 0.4 vs 4.3 ± 0.4, P 〈 0.05 ） in nonresponders without deteriorating oxygenation. And oxygen delivery index（ DO2I） , DO2I decreased significantly （463 ± 31 vs 416 ± 35, P 〈 0.05 ） after fluid challenge in nonresponders. Conclusion SVV and PPV failed to predict fluid responsiveness in acute respiratory distress syndrome patients. Fluid challenge did not aggravate lung edema or oxygenation but fluid should be restricted in those nonresponders.

关 键 词：每博排出量变异 脉压差变异 急性呼吸窘迫综合征 液体反应 

分 类 号：R472.9[医药卫生—护理学]