经皮氧分压监测在被动抬腿试验评估容量反应性中的价值  

The value of changes in transcutaneous partial pressure of oxygen induced by passive leg raising in evaluating fluid responsiveness

作　　者：方红龙[1] 吴华勇[1] 陈娟[2] 罗建[1] 王丹琼[1] 张伟文[1] 

机构地区：[1]衢州市人民医院重症医学科,浙江衢州324000 [2]衢州市人民医院检验科,浙江衢州324000

出　　处：《中国急救医学》2017年第4期318-321,共4页Chinese Journal of Critical Care Medicine

基　　金：浙江省卫生厅资助项目（2014KYB302）

摘　　要：目的探讨经皮氧分压（transcutaneous partial pressure of oxygen，PtcO2）在被动抬腿试验（passive leg raising，PLR）评估容量反应性中的价值。方法选择2014-01～2015—12需行液体容量评估的机械通气患者89例，在PLR前后采用脉搏指示连续心输出量（pulse indicator continuous cardiac output，PiCCO）监测患者血流动力学变化，经皮氧分压监测装置监测患者PtcO2，采用Pearson法分析PLR后PtcO2变化（△PtcO2）与心指数变化（△CI）的关系，以受试者工作曲线（ROC曲线）分析PtcO2变化在PLR评估容量反应性中的价值，以△CI≥15％为对容量治疗有反应组，否则为无反应组。结果①89例重症患者中，52例有容量反应性（有反应组），37例无容量反应性（无反应组）；有反应组患者PLR后CI及PtcO2较基线值明显增加（P〈0．05），无反应组CI和PtcO2较基线值无变化（P〉0．05）。②△CI与△PtcO2呈正相关r=0．829，P〈0．05）。③△PteO2〉11．5％判断容量反应性的AUC值为0．911，敏感度为84．7％，特异度为90．4％。结论PtcO2变化可以作为PLR评估容量反应性的无创、简单指标。Objective To test whether the changes of transcutaneous partial pressure of oxygen （PtcO2） during passive leg raising（PLR） test evaluate fluid responsiveness. Methods Eighty - nine mechanically ventilated patients who need fluid evaluation admitted from January 2014 to December 2015 were prospectively recruited. Hemodynamic parameters monitored by a pulse indicator continuous cardiac output （PiCCO） device and PtcO2, monitored by an transcutaneous oxygen monitoring device were studied at baseline and after PLR. The correlation between PLR - induced CI change （ A CI） and PtcO2 （ A PtcO2） was analyzed by Pearson analysis. The value of A PtcO2 induced by passive leg raising to predict fluid responsiveness was evaluated by receiver operating characteristic （ROC） curves. Fluid responsiveness was defined as an increase in cardiac index （CI） of 15 % or greater after PLR（responders： △ CI≥ 15%; nonresponders： △ CI 〈 15% ）. Results A total of 89 patients were enrolled in this study, of whom 52 had a CI increase of ≥ 15 % after PLR （responders）. After PLR, CI and PtcO2 were both sig-nificantly increased in the response group compared with baseline （P〈 0.05）, while no significant changes were observed in the non - response group （P 〉 0.05）. △ CI and △ PteO2, after PLR were strongly correlated （r = 0.829, P 〈 0.05）. After PLR, the area under ROC curve of △ PtcO2 was 0.911. An increase of 〉 11.5% in A PtcO： predicted fluid responsiveness with a sensitivity of 84.7%and speci- ficity of 90.4 %. Conclusion The change of PtcO2 induced by PLR is a non - invasive and easy way to predict fluid responsiveness in critical patients.

关 键 词：经皮氧分压(PtcO2) 被动抬腿试验(PLR) 容量反应性 

分 类 号：R768.1[医药卫生—耳鼻咽喉科]