呼气末阻断试验联合脉搏轮廓分析技术对机械通气-休克患者容量反应性的预测价值  

Predictive value of end-expiratory occlusion and pulse contour-derived cardiac index on fluid responsiveness in shock patients with mechanical ventilation

作　　者：柳开忠[1] 曹永卿[1] 沈珏[1] 柳杰铭[1] 

机构地区：[1]浙江省肿瘤医院重症医学科,杭州310022

出　　处：《中华危重症医学杂志（电子版）》2015年第3期16-21,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

摘　　要：目的探讨呼气末阻断试验(EEO)联合脉搏轮廓分析技术(Pi CCO)对机械通气-休克患者容量反应性的预测价值。方法取40例机械通气-休克患者,根据补液试验后心脏指数增加值(ΔCI)是否≥15%分为容量反应组(25例)及无反应组(8例),其中7例患者因EEO时自主呼吸太强而触发呼吸机被排除。观察被动抬腿试验(PLR)、EEO及补液试验前后心率、平均动脉压(MAP)及心脏指数的变化。对PLR、EEO前后与补液试验前后MAP增加值(ΔMAP)与ΔCI进行pearson相关分析并绘制ROC曲线分析PLR、EEO预测ΔMAP及ΔCI的敏感度及特异度。结果容量反应组患者中PLR、EEO及补液试验后MAP(t=5.021、4.365、4.332,P=0.030、0.042、0.044)、心脏指数水平(t=7.584、7.028、6.727,P=0.008、0.011、0.013)均明显高于试验前。且PLR、EEO前后与补液试验前后ΔMAP(r=0.383、0.506,P=0.028l、0.003)、ΔCI(r=0.622、0.629,P均<0.001)均呈正相关。ROC曲线显示,PLR后MAP和心脏指数变化预测容量反应性的ROC曲线下面积分别是0.777[95%CI(0.624,0.931)]和0.957[95%CI(0.894,0.999)],EEO后MAP和心脏指数变化预测容量反应性的ROC曲线下面积分别是0.865[95%CI(0.740,0.990)]和0.950[95%CI(0.875,0.998)]。PLR预测MAP、心脏指数的敏感度分别为66%、78%,特异度均为100%,EEO预测MAP、心脏指数的敏感度分别为76%、82%,特异度均为100%。结论应用EEO联合Pi CCO对行机械通气休克患者的容量反应性指标有较好的预测价值。Objective To explore the predictive value of end-expiratory occlusion tests（EEO） and pulse contour-derived cardiac index（Pi CCO） on fluid responsiveness in mechanically ventilated patients with shock. Methods Forty mechanically ventilated patients with shock were divided into the response group（25 cases） and non-response group（8 cases） according to the cardiac index after fluid resuscitation（ΔCI） ≥15%, and 7 patients were excluded due to the strong spontaneous breathing on EEO. The heart rates, mean arterial pressure（MAP） and cardiac index were determined by Pi CCO before and after passive leg raising（PLR）, EEO and fluid resuscitation. The changes of MAP（ΔMAP） and cardiac index（ΔCI） during PLR, EEO and f luid resuscitation were analyzed by pearson correlation analysis. The receiver operating characteristic curve was used to predict the ΔMAP and ΔCI after PLR and EEO. Results The levels of MAP（t = 5.021, 4.365, 4.332, P = 0.030, 0.042, 0.044） and cardiac index（t = 7.584,7.028, 6.727, P = 0.008, 0.011, 0.013） after PLR, EEO and fluid resuscitation were all higher than those before all the tests. The ΔMAP（r = 0.383, 0.506, P = 0.028 l, 0.003） and ΔCI（r =0.622, 0.629, all P 0.001） between PLR, EEO and fluid resuscitation all showed positive interrelation. The area under the receiver operating characteristic curve for MAP and cardiac index in PLR were 0.777 [95% CI（0.624, 0.931）] and 0.957 [95% CI（0.894, 0.999）], respectively.The area under the receiver operating characteristic curve for MAP and cardiac index in EEO were 0.865 [95%CI（0.740, 0.990）] and 0.950 [95%CI（0.875, 0.998）], respectively. The sensitivity of PLR in predicting the MAP and cardiac index were 66%, 78%, and specificity all were 100%. The sensitivity of EEO in predicting the MAP and cardiac index were 76%,82%, and specificity all were 100%. Conclusion The EEO and Pi CCO can predict fluid responsiveness in mechanically ventilated patients with shock.

关 键 词：休克 通气机 机械 容量反应性 呼气末阻断试验 脉搏轮廓分析技术 

分 类 号：R459.7[医药卫生—急诊医学]