感染性休克患者下腔静脉直径变异度与动脉血乳酸清除率的关系  

Relationship between diameter variation of inferior vena cava and arterial lactate clearance in patients with infective shock

作　　者：陈曦[1] 田锁臣[1] 许志平[1] 王强[1] 吴铁军[1] Chen Xi;Tian Suo-chen;Xu Zhi-ping;Wang Qiang;Wu Tie-jun(Department of Critical Care Medicine, Liaocheng People's Hospital, Liaocheng 252000, China)

机构地区：[1]聊城市人民医院重症医学科,山东聊城252000

出　　处：《中国急救医学》2019年第2期106-109,共4页Chinese Journal of Critical Care Medicine

基　　金：山东省医药卫生科技发展计划项目(2015WS0390).

摘　　要：目的探讨感染性休克患者早期液体复苏治疗中下腔静脉直径(inferior vena cava diameter,IVCD)变异度(△IVCD)与动脉血乳酸清除率的关系。方法选取2016年3月至2018年3月重症监护病房(ICU)收治的需行机械通气的感染性休克患者共54例,对所有患者根据早期目标导向治疗(early goal-directed therapy,EGDT)方案按6h脓毒症集束化治疗(bundle)行液体复苏,按照达标与否将患者分为达标组(39例)与未达标组(15例),对所有患者监测并记录液体复苏前的一般状况、△IVCD及动脉血乳酸值,液体复苏6h后的△IVCD及动脉血乳酸值,对监测数据进行统计学分析。结果液体复苏后,达标组患者△IVCD明显低于未达标组(%:24.43±6.11vs.30.44±5.42,P<0.05),动脉血乳酸清除率明显高于未达标组(%:21.72±14.77vs.9.64±7.40,P<0.05);达标组△IVCD与动脉血乳酸清除率为明显负相关(P<0.05);使用△IVCD判断感染性休克患者液体复苏是否达标,其曲线下面积为0.827,当其临界值为25.66%时,敏感度为93.3%,特异度为71.2%;使用动脉血乳酸清除率判断感染性休克患者液体复苏是否达标,其曲线下面积为0.765,当其临界值为18.36%时,敏感度为73.3%,特异度为76.9%。结论感染性休克患者按EGDT方案行6hBundle液体复苏后,达标组△IVCD更低,动脉血乳酸清除率更高,且两者之间有明显负相关性,用△IVCD判断液体复苏是否达标敏感度更高。Objective To discuss the relationship between the diameter variation of inferior vena cava (AIVCD)and the arterial lactate clearance during early fluid resuscitation in patients with infective shock.Methods Fifty -four patients with infective shock who were treated with mechanical ventilation from March 2016 to March 2018 were selected,and according to the early goal directed therapy,all patients were given fluid resuscitation at 6 hours Bundle.Then they were divided into the reaching standard group (39 cases)and the non -reaching standard group (15 cases)according to whether or not they reached the standard.All patients were recorded the general condition,the diameter variation of inferior vena cava,the level of lactic acid in arterial blood before the fluid resuscitation;Meanwhile,the diameter of inferior vena cava and level of lactic acid in arterial blood were monitored after 6 hours of fluid resuscitation.Finally,the data of monitoring were statistically analyzed.Results After the fluid resuscitation,the diameter variation of the inferior vena cava in the standard group was significantly lower than that in the non -standard group (%:24.43 ±6.11 vs.30.44 ±5.42,P <0.05), and the arterial lactate clearance was significantly higher than that in the non -standard group (%:21.72 ±14.77 vs.9.64±7.40,P <0.05 ).The diameter variation of inferior vena cava was significantly negatively correlated with the arterial lactate clearance in standard group (P <0.05).When the diameter of the inferior vena cava was used to determine whether the fluid resuscitation in the patients with infective shock reached the standard,the area under the curve was 0.827,the critical value was 25.66%,the sensitivity was 93.3%,and the specificity was 71.2%.When the arterial lactate clearance was used to determine whether the fluid resuscitation in the patients with infective shock reached the standard,the area under the curve was 0.765,the critical value was 18.36%,the sensitivity was 73.3%,and the specificity was 76.9%.Conclusion For patie

关 键 词：感染性休克 液体复苏 床旁超声 下腔静脉直径变异度(△IVCD) 动脉血乳酸清除率 

分 类 号：R459.7[医药卫生—急诊医学]