被动抬腿联合心脏超声预测容量反应性的临床研究  

Study of the predict of capacity reactivity response of senile shock through passive leg raising combined with cardiac ultrasound

作　　者：石朝积 张永辉[2] 李刚 张小琴 

机构地区：[1]重庆市万州区第五人民医院重症监护室,404120 [2]第三军医大学附属第一医院西南医院重症医学科,重庆400038 [3]重庆市三峡中心医院肿瘤分院,404000 [4]重庆市万州区第五人民医院彩超室,404120

出　　处：《重庆医学》2016年第26期3646-3649,共4页Chongqing medicine

基　　金：重庆市医学会临床科研专项资金项目(wx2013-026)

摘　　要：目的探讨被动抬腿试验(PLR)联合超声检测心输出量(CO)方法对老年休克患者容量反应性预测的可行性。方法采取前瞻性观察研究方法,选择万州区第五人民医院ICU 2013年1月至2015年9月老年休克患者38例,先后行PLR及补液疗法。按补液疗法后超声检测CO增加百分比大于或等于10%为对容量治疗有反应组,否则为无反应组。结果 38例患者行45例次补液疗法,有反应组13例,无反应组32例。有反应组PLR及补液后CO明显增加(P<0.05),两组数值△COPLR为(8.36±4.02)%,ΔCO补液为(8.59±3.53)%;观察有反应组ΔCOPLR与ΔCO补液两组变量呈正相关(r=0.815,P=0.01)。ΔCOPLR预测容量反应性的AUC值为0.854。当阈值ΔCOPLR≥15%时,预测容量反应性敏感性87%,特异性91%。结论 PLR联合超声对CO检测可有效预测容量反应性,可作为一种无创方法指导老年患者休克治疗。Objective Through investigating the testing of Cardiac Output （CO） through Passive leg raising （PLR） com- bined with cardiac cltrasound,to predict the practicability of body volume response of elderly shock patients. Methods Adopt the method of prospective observational,selected 38 Shock senile patients who need to fluid resuscitation from Jan. 2013 to Sep. 2015. PLR and Fluid resuscitation experiments were performed successively in the the Heart rate （HR） ,Mean arterial pressure （MAP）, CO and other index of hemodynamics. After fluid infusion test, the percentage increase of the CO greater than or equal to 10 % were followed in reaction group otherwise nonreaction group. Results There were 45 testings of fluid resuscitation for 38 Shock pa- tients,including 13 cases of reaction group and 32 cases of nonreaction group. Compare with pre-experiment, PLR and CO in the pa- tients of reaction group were increased obviously（P〈0.05）. Two sets ,of values are △COPLR （8. 36± 4. 02） % ;and ACO （8. 59± 3.53） %. No significant change were found in PLR and CO of patients in Nonreaction group （P〉0.05） ,compared the Basic values of this two sets with H R,SBP,DBP, MAP,CO has nor statistical significance（P〉0.05）. The COts value of predictive Capacity re- activity is 0. 854 after and before PLR. When the threshold（△COPLR） is greater than or equal to 15 %, The sensibility of predictive capacity reactivity is 87 % and the specificity is 91%. Conclusion According to the monitoring the CO by PLR and Ultrasonic, it can reflect the condition and volume load of the body. Predict the response of the body to the Fluid resuscitation experiments. It can also be used as a noninvasive method to guide the treatment of shock in senile patients.

关 键 词：补液疗法 每博输出量 被动抬腿试验 心脏超声 容量反应性 

分 类 号：R459.7[医药卫生—急诊医学]