被动抬腿试验联合PiCCO预测老年脓毒性休克患者容量反应性的临床价值  

Clinical value about volume responsiveness through passive leg raising test combined with PiCCO in elderly patients with septic shock

作　　者：展思东[1] 庄志辉[1] 蔡雪[1] 乐胜[1] 江霞[1] 

机构地区：[1]广东省惠州市中心人民医院急诊重症病区,广东惠州516000

出　　处：《中国医药导报》2016年第1期66-70,共5页China Medical Herald

摘　　要：目的分析被动抬腿试验(PLRT)联合PiCCO预测老年脓毒性休克患者容量反应性的价值。方法采用前瞻性、观察性队列设计方法,收集2014年9月~2015年9月惠州市中心人民医院急诊ICU的老年脓毒性休克患者21例,所有患者进行序贯器官衰竭估计评分(SOFA)及APACHE-Ⅱ评分,采用PLRT和补液试验(10 min内输注250 mL生理盐水),结合PiCCO技术,测定PLRT前后和补液前后心率(HR)、中心静脉压(CVP)、动脉收缩压(SAP)、平均动脉压(MAP)、脉压(PP)、脉搏指示心指数(PCCI)、每搏量(SV)等参数变化,将患者分为有反应组和无反应组,通过受试者工作曲线评价PLRT预测容量反应性价值。结果 21例患者共进行67次PLRT和补液测试,其中26例次患者补液试验有反应。经PLRT,容量有反应组患者PLRT后PCCI[(4.6±1.1)L/(min·m^2)]、SV[(80±7)mL]较PLRT前[(4.1±0.6)L/(min·m^2)、(66±7)mL]明显增加,差异均有统计学意义(P<0.05);PLRT试验前后患者HR、CVP、SAP、MAP比较,差异无统计学意义(P>0.05)。PLRT-ASV(PLRT诱导的每搏量变化率)与补液试验后ASV(补液试验诱导的每搏量变化率)呈正相关(r=0.91,P<0.05);PLRT-△PP与△SV呈正相关(r=0.84,P<0.05)。PLRT-△SV预测容量反应性最佳临界值、灵敏度和特异度分别为14.5%、92.3%、87.8%,PLRT-△PP预测容量反应性最佳临界值、灵敏度和特异度分别为12.0%、84.6%、85.4%。结论 PLRT联合PiCCO可用来评估老年脓毒性休克患者容量反应性。PLRT-△SV可作为指导容量复苏的可靠指标。PLRT-△PP可作为PLRT-△SV的替代指标。Objective To investigate the value of PiCCO with passive leg raising test（PLRT） in volume responsiveness of elderly septic shock patients.Methods A prospective cohort study was designed.21 elderly patients with septic shock in EICU of Huizhou Municipal Central Hospital from September 2014 to September 2015 were enrolled.All patients were scored with APACHE-Ⅱ and sepsis-related organ failure assessment（SOFA）.Hemodynamic changes were determined by pulse-contour derived cardiac index（PiCCO plus） before and after PLRT;before and after fluid challenge（250 mL saline for 10 min）,parameters heart rate（HR）,central venous pressure（CVP）,systolic blood pressure（SAP）,mean arterial pressure（MAP）,pulse pressure（PP）,pulse indicates cardiac index（PCCI） and stroke volume（SV）were monitored.Patients were divided into response group and non-response group.The value of PLRT predicting volume responsiveness was evaluated by receiver operating curves.Results PLRT and fluid challenge were performed 67 instances,among which 26 instances were defined as response group.PCCI[（4.6±1.1）L/（min·m^2）],SV[（80±7） mL]after PLRT were increased significantly in response group,compared with before PLRT[（4.1±0.6） L/（min·m^2）,（66±7） mL],the differences were statistical significance（P〈0.05）.There were no significant changes in HR,CVP,SAP and MAP（P〈0.05）.PLRT-△SV was positively correlated with ASV（r=0.91,P〈0.05）,PLRT-△PP（PLRT induced changes in stroke volume） was positively correlated with ASV（the rate of change of stroke volume induced by fluid infusion test）（r=0.84,P〈0.05）.PLRT-△SV predict volume responsiveness optimal threshold was 14.5%,PLRT-△SV predict volume responsiveness sensitivity was 92.3%,and PLRT-△SV predict volume responsiveness specificity was 87.8%.PLRT-△PP predict volume responsiveness optimal threshold was 12.0%PLRT-△PP predict volume responsiveness sensitivity was 84.6%,PLRT-△PP predict volume responsiveness specifi

关 键 词：脓毒性休克 容量反应性 被动抬腿试验 老年患者 

分 类 号：R541.4[医药卫生—心血管疾病]