每搏量变异对于预测感染性休克患者容量反应的临床价值  

Clinical value of stroke volume variation for predicting the volume responsiveness in patients with septic shock

作　　者：唐宇涛[1] 俞宁[1] 沈印[1] 

机构地区：[1]广西壮族自治区人民医院急诊科,广西南宁530021

出　　处：《中国临床研究》2016年第6期749-752,共4页Chinese Journal of Clinical Research

基　　金：广西壮族自治区卫生厅科研课题(Z2013317)

摘　　要：目的探讨每搏量变异（SVV）对感染性休克患者容量反应预测的准确性,为临床诊治感染性休克提供参考依据。方法选择2013年8月至2015年9月期间收治的40例外科感染性休克患者为研究对象,以羟乙基淀粉静脉输注做容量负荷试验,以每搏量指数（SVI）作为容量反应性指标,SVI增值≥10%为有反应组,SVI增值0.05）,但在容量负荷后两组SVV值比较差异有统计学意义（P〈0.01）。ROC曲线分析表明：SVV监测容量反应性的阈值为12.5%时,其特异性为100%,灵敏度为80%,曲线下面积为0.747（95%CI：0.544~0.953）。结论 SVV可作为临床预测感染性休克患者补液治疗容量反应性的常规指标。Objective To explore the clinical values of stroke volume variation（ SVV） for evaluating volume responsiveness in patients with septic shock in order to provide a reference for fluid replacement. Methods Forty surgical patients with septic shock from August 2013 to November 2015 were selected as study objects. Volume-loading test was performed with hydroxyethyl starch infusion,and stroke volume index（ SVI） was served as an indicator estimating volume responsiveness. The patients with SVI increased value more than or equal to 10% were served as reaction group,and the patients with SVI increased value less than 10% were served as no-reaction group. The central venous pressure（ CVP）,heart rate（ HR）,mean arterial pressure（ MAP）,cardiac output（ CO）,SVI,SVV were measured by pulse-indicative continuous cardiac output（ PICCO）. The clinical value of SVV for evaluating volume responsiveness was explored,and its sensitivity and specificity were analyzed with receiver operating characteristic（ ROC） curve. Result Out of 40 patients,30 were positive volume reaction,and 10 were negative volume reaction. There were no statistical differences in HR,MAP,CO,CVP,SVI and SVV before and after volume-loading test between two groups（ all P 0. 05）,but there was significant difference in SVV after volume-loading test between two groups（ P 0. 05）. ROC curve analysis showed that as the threshold of SVV for monitoring volume responsiveness was 12. 5%,its specificity and sensitivity were 100% and 80%,respectively. AUC was0. 747（ 95% CI： 0. 544- 0. 953）. Conclusion SVV can be used as a conventional clinical indicator to predict volume responsiveness in the treatment of fluid replacement for the patients with septic shock.

关 键 词：容量反应 每搏量变异 每搏量指数 预测 感染性休克 

分 类 号：R631.4[医药卫生—外科学]