小剂量容量负荷试验联合脉搏轮廓分析技术对老年感染性休克患者容量反应性的预测价值  

Predictive value of low volume volume expansion and pulse contour - derived cardiac index on fluid responsiveness in elderly patients with septic shock

作　　者：粱锋鸣[1] 杨挺[1] 严洁[1] 

机构地区：[1]南京医科大学附属无锡市人民医院重症医学科,江苏无锡214023

出　　处：《中国急救医学》2017年第4期312-317,F0003,共7页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨小剂量容量负荷试验（Low—VE）联合脉搏轮廓分析技术（PiCCO）对老年感染性休克患者容量反应性的预测价值。方法采用前瞻性观察性队列研究方法，选择2014—05～2016—04本院重症医学科收治的46例老年感染性休克患者。分别于试验前、Low—VE后（1min内输注100mL生理盐水）、容量负荷试验（VE）后（10min内输注250mL生理盐水）三个阶段记录血流动力学指标，根据VE后每搏量变化值（ASVVE）将患者分为液体复苏有反应组（ASVVE≥15％）和液体复苏无反应组（△SVVE〈15％）。绘制受试者工作特征（ROC）曲线，分析各血流动力学指标预测容量反应性的敏感度及特异度。结果46例患者中16例为有反应组，30例为无反应组。有反应组Low—VE后引起的SV变化值（△SVLow-VE）及心排血量（CO）变化值（△SCOlOW-VE）较无反应组明显升高[△SVLow-VE：（11．0±3．5）％比（4．6±2．7）％，t=6．882，P=0．000；△COLow-VE（9．7±4．5）％比（4．1±3．2）％，t=4．857，P=0．000]，而Low—VE引起的收缩压（SBP）、平均动脉压（MAP）、脉搏压（PP）、心率（HR）的变化值（△SBPLow-VE、△MAPLow-VE、△PPLow-VE、△HRLow-VE）在两组间比较差异无统计学意义。以△SVLow-VE≥8．1％预测患者容量反应性的ROC曲线下面积（AUC）为0．928±0．042（P=0．000），敏感度为81．2％，特异度为93．3％；以△COLow-VE。旁6．3％预测患者容量反应性的AUC为0．858±0．057（P=0．000），敏感度为87．5％，特异度为73．3％。结论在老年感染性休克患者中，Low—VE引起的SV及CO变化值能准确预测容量反应性，而其引起的SBP、MAP、PP、HR的变化值及每搏量变异率（SVV）均不能有效预测容量反应性。Objective To explore the predictive value of low volume volume expansion （Low - VE） and pulse contour - derived cardiac index （PiCCO） on fluid responsiveness in elderly patients with septic shock. Methods A prospective observational cohort study was conducted. Forty - six elderly patients suffering from septic shock admitted to Department of Intensive Care Unit of our hospital from May 2014 to April 2015 were enrolled. The patients were studied in three phases： before test, Low - VE （100 mL saline infused with 1 minute）, and volume expansion （VE） with infusing of 250 mL saline within 10 minutes. Hemodynamic parameters were recorded in every phase. Responders and nonresponders were defined by stroke volume （SV） variation after VE. A positive response was defined as a ≥15% increase in SV （△SVVE≥15%）. The receiver operating characteristic （ROC） curve was used to predict the value of hemodynamic parameters before and after Low - VE. Results Of 46 patients, 16 patients were responders, and 30 non - responders. The changes in SV and cardiac output （CO） after Low - VE （△SVLow-VE and △COLow-VE） were significantly higher in responders than those of non - responders [△SVLow-VE： （11.0± 3.5）% vs. （4.6±2.7）%, t =6.882, P = 0.000; △COLow-VE： （9.7±4.5）% vs. （4.1±3.2）%, t = 4.857, P= 0.000], but there was no significant difference in the changes in systolic blood pressure （SBP）, mean arterial pressure （MAP）, pulse pressure （PP）, and heart rate （HR） after Low - VE （△SBPlow-VE, △MAPLow-VE, △PPLow- VE and △HRLow-VE） between two groups. The area under ROC curve （AUC） of △SVLow -VE≥8.1% for predicting fluid responsiveness was （0.928±0.042, P= 0.000）, with sensitivity of 81.2% and specificity of 93.3%; the AUC of △COLow-VE≥6.3% for predicting fluid responsiveness was （0.858±0.057, P = 0.000）, with sensitivity of 87.5% and specificity of 73.3%. Conclusion In elderly patients with septic shock, changes in SV and

关 键 词：感染性休克 老年 容量反应性 脉搏轮廓分析技术(PiCCO) 

分 类 号：R541.4[医药卫生—心血管疾病]