脓毒性休克机械通气患者进行液体复苏治疗时SVV对容量反应性的预测价值  

Predictive value of SVV for volume response in fluid resuscitation in the treatment of mechanically ventilated patients with septic shock

作　　者：叶照伟 陈洁[1] 邵汉权 

机构地区：[1]广东省东莞市人民医院重症医学科,广东东莞523059

出　　处：《中国当代医药》2017年第23期21-23,33,共4页China Modern Medicine

基　　金：广东省东莞市科技计划医疗卫生类科研一般项目(201410515000082)

摘　　要：目的探讨液体复苏治疗时每搏量变异度(SVV)对脓毒性休克机械通气患者容量反应性的预测价值。方法对2014年12月~2015年12月我院收治的58例脓毒性休克机械通气患者进行液体复苏治疗。根据液体复苏前后的CI差值分为研究组(32例)和对照组(26例)。观察记录两组的心功能各项指标,包括每搏量变异度(SVV)、中心静脉压(CVP)、心率(HR)、平均动脉压(MAP)、心排出量(CO)、胸腔内血容量指数(ITBVI)、心排血指数(CI),并对SVV和CVP与CI差值(ΔCI)的相关性进行分析。结果对照组液体复苏前的SVV、CVP、HR、MAP、CO、ITBVI、CI水平均优于研究组,差异有统计学意义(P<0.05)。两组液体复苏后的SVV、CVP、HR、MAP、CO、ITBVI、CI水平均明显改善,且研究组液体复苏后的SVV、MAP、CO、CI水平明显优于对照组,差异有统计学意义(P<0.05)。对两组患者液体复苏前后的SVV、CVP与ΔCI做相关性分析发现,液体复苏后,SVV与ΔCI(r=0.763,P=0.008)及CVP与ΔCI(r=0.386,P=0.038)均成正相关,且SVV与ΔCI的相关性比CVP与ΔCI的相关性更明显。结论相比于其他的预测容量指标,SVV更具有有效性,值得在临床上推广。Objective To explore the predictive value of stroke volume variation （SVV） for volume response of fluid re- suscitation in the treatment of mechanically ventilated patients with septic shock.Methods A total of 58 patients with septic shock mechanical ventilation from December 2014 to December 2015 in our hospital were treated with liquid re- suscitation,the patients were divided into the study group （32 cases） and the control group （26 cases） according to the dif- ference of CT before and after resuscitation.The heart function indexes of the two groups were observed and recorded, including stroke volume variation （SVV）,eentral venous pressure （CVP）,heart rate （HR）,mean arterial pressure （MAP）, cardiac output （CO）,intrathoraeie blood volume index （ITBVI）,cardiae index （CI）,and the correlation between SVV and CVP, CI difference （ACI） was analyzed.Results The levels of SVV,CVP,HR,MAP,CO,ITBVI and CI in the control group before fluid resuscitation was better than that in the study group,with significant difference （P〈0.05）.The levels of SVV,CVP, HR,MAP,CO,ITBVI and CI in the two groups after fluid resuscitation were significantly improved,and the levels of SVV, MAP, CO and CI in the study group after fluid resuscitation was significantly better than that in the control group,with significant difference （P〈0.05）.The correlation analysis of SVV,CVP and CI of the two groups were analyzed before and after the fluid resuscitation,after fluid resuseitation,SVV and ACI （r=0.763,P=0.008）,CVP and ACI （r=0.386,P=0.038） were positively correlated,and the correlation between SVV and ACI was more obvious than that of CVP and ACI.Conclusion Compared with other predictive capacity indexes,SVV is more effective and is worthy of clinical promotion.

关 键 词：液体复苏 脓毒性休克 每搏量变异度 容量反应性 机械通气患者 

分 类 号：R631.4[医药卫生—外科学]