每搏变异度、脉搏压变异度的变化评价感染性休克患者容量反应性的临床研究  

A prospective clinical study of pulse pressure and stroke volume variations in prediction of fluid responsiveness in septic shock patients

作　　者：李跃东[1] 周翔[2] 王亚朋[1] LI Yue-dong ZHOU Xiang WANG Ya-peng(Department of Critical Care Medicine, 105 Hospital of PLA, Anhui Hefei 230000, China Department of Critical Care Medicine, Peking Union Medical College Hospital Beijing 100730, China)

机构地区：[1]解放军105医院重症医学科,安徽合肥230000 [2]中国医学科学院北京协和医学院北京协和医院重症医学科,北京100730

出　　处：《中国医刊》2016年第10期91-94,共4页Chinese Journal of Medicine

摘　　要：目的通过容量负荷试验评价每搏变异度(stroke volume variation,SVV)、脉搏压变异度(pulse pressure variation,PPV)的变化预测感染性休克机械通气患者的容量反应。方法对解放军105医院重症医学科2013年5月至2015年5月32例感染性休克患者给予容量负荷试验。脉波轮廓温度稀释连续心排量技术(pulse indicator continous cardiac output,Pi CCO)持续监测平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、心输出量(cardiac output,CO)、心脏指数(cardiac index,CI)、每搏输出量(stroke volume,SV)、SVV、PPV。以提高患者CI 15%为目标,△CI≥15%定义为容量反应阳性(有反应组),△CI<15%定义为容量反应阴性(无反应组)。比较两组血流动力学参数前后变化值;并通过绘制受试者工作特征曲线(receiver operating characteristic,ROC)评价上述参数评估容量反应性的价值。结果容量负荷试验前两组间心率、MAP、CVP、CO、SV、SVV、PPV、CI差异均无显著性。容量负荷试验后,有反应组与之前比较差异均有显著性。△SVV和△PPV的ROC曲线下面积分别是0.817、0.857,均高于△SV和△CVP。结论对于机械通气的感染性休克患者,△PPV和△SVV可作为预测容量反应性的血流动力指标。Objective To investigate the clinical role of changes in pulse pressure and stroke volume variations to evaluate fluid responsiveness in septic shock patients.Method 32 patients with septic shock were studied. Before and after volume challenge, mean arterial pressure （MAP）, central venous pressure（CVP）, cardiac output（CO）, cardiac index （CI）, stroke volume（SV）, stroke volume variation （SVV）, pulse pressure variation（PPV） were monitored by pulse indicated continuous cardiac output （PiCCO）. Responsive group： responders were viewed as an increase in cardiac index （△CI）≥ 15% after fluid challenge. Unresponsive group： non-responders were regarded as a growing in CI〈 15% after volume expansion. The changes in dynamic parameters before and after fluid challenge were analysed. The role of the hemodynamic parameters for fluid responsiveness prediction was assessed by receiver operating characteristic （ROC） curves.Result There were no statistically significant differences in dynamic indices HR, MAP, CVP, CO, SV, SVV, PPV and CI before fluid challenge between the responsive and unresponsive group. The△SVV and△PPV predicted fluid responsiveness with the area under ROC curve （AUC） of 0.817 and 0.857,respectively. They were higher than△SV and△CVP.Conclusion△SVV and△PPV were good indicators of fluid responsiveness in mechanically ventilated patients suffering septic shock.

关 键 词：每搏变异度 脉搏压变异度 感染性休克 容量反应性 

分 类 号：R631.4[医药卫生—外科学]