呼气末屏气试验评估肿瘤重症患者容量反应性的临床研究  

Application of end-expiratory occlusion test in predicting volume responsiveness of critically ill cancer patients

作　　者：柳开忠[1] 沈珏[1] 曹永卿[1] 黄剑[1] 

机构地区：[1]浙江省肿瘤医院重症医学科,杭州310022

出　　处：《浙江医学》2015年第10期820-822,870,共4页Zhejiang Medical Journal

摘　　要：目的探讨呼气末屏气试验(EEO)预测肿瘤重症患者容量反应性的价值。方法采用外周动脉压心排量监测(APCO)技术监测32例肿瘤重症患者在基础状态、EEO前及EEO时的血流动力学变化,EEO稳定后行补液试验,监测补液试验前后血流动力学的变化。以补液试验后心指数(CI)增加值(△CI)≥15%为容量反应组,否则为无反应组。评价EEO前和EEO时CI的变化(EEO-△CI)预测容量反应性的价值。结果有反应组共17例,EEO时CI为(3.2±0.8)L/(min·m^2),较EEO前明显增加[(3.0±0.7)L/(min·m^2),P<0.05];无反应组共15例,EEO时CI为(3 1±0.8)L/(min·m^2),EEO前CI为(3.0±0 7)L/(min·m^2),两者无明显变化(P>0.05)。EEO-△CI与补液试验后△CI呈正相关(r=0.640,P<0.05),心率、平均动脉压(MAP)和中心静脉压(CVP)与补液试验后△CI无相关性(r=0.09、0.23、0.27,均P>0 05)。EEO-△CI预测容量反应性的ROC曲线下面积为0 786,以EEO-△CI≥5%评价容量反应性,灵敏度为94.1%,特异度为86.7%。结论应用APCO测定由EEO所引起的CI变化能较准确预测肿瘤重症患者液体治疗时的容量反应性,可作为指导容量治疗的指标。Objective To assess the predicting value of the end-expiratory occlusion test （EEO） in critically ill cancer patients. Methods Hemodynamic changes were determined by arterial pressure waveform analysis of cardiac output （APCO） at baseline, during EEO, return to baseline for at least 30 seconds, before and after fluid challenge. Thirty-two critically ill cancer patients in whom the fluid challenge-induced increase in cardiac index （FC-△CI）〉15% were defined as responders. The role of the change in CI during EEO（EEO-△CI） for predicting volume responsiveness was evaluated by receiver operating characteristic （ROC） curves. Results Of 32 cases, 17 were in response group and 15 cases were in non-response group. The change in CI during EEO （EEO-△CI） was increased significantly in response group [（3.2 ±0.8）, （3.0 ±0.7）L/min/m^2, P〈0.05], while in non-response group there were no significant changes [（3.1 ±0.8）, （3.0 ±0.7） L/min/m^2, P 〉0.05]. EEO-△CI was positively correlated with FC-△CI（r=0.640, P=0.000）, heart rate, mean arterial pressure （MAP） and central venous pressure（CVP）, while was not correlated with FC-△CI. The area under curve （AUC） in the graph of the receiver operating characteristic curves（ROC curves） for EEO-△CI was 0.786. Fluid responsiveness was predicted by EEO-△CI ≥5% with a sensitivity and a specificity of 94.1% and 86.7% respectively. Conclusion EEO-△CI measured by APCO can predict the fluid responsiveness in critically ill cancer patients and it is reliable to guide fluid therapy.

关 键 词：呼气末屏气试验 容量反应性 外周动脉压心排量监测 心指数 

分 类 号：R730.4[医药卫生—肿瘤]