USCOM联合PLR预测老年脓毒症患者容量反应性研究  

The prediction of volume response in elderly patients with sepsis by USCOM and PLR

作　　者：孙乾辉[1] 孙婷[1] 张健[1] 曹宇亮 曹加明[1] Sun Qihui

机构地区：[1]中国人民解放军72集团军医院,浙江湖州31300

出　　处：《浙江临床医学》2019年第8期1012-1014,共3页Zhejiang Clinical Medical Journal

基　　金：2015年度南京军区医学科技创新课题(15MS007).

摘　　要：目的评价无创超声心排血量监测技术(USCOM)联合被动抬腿试验(PLR)预测老年脓毒症患者容量反应性的价值.方法选择2015年5月至2018年1月入住本院ICU需要液体复苏的老年脓毒症患者46例,先后进行PLR和容量负荷试验(VE).将VE后每搏输出量(SV)增加值(△SVve)≥10%定义为有容量反应性.将患者分为有反应组和无反应组.采用受试者工作特征曲线(ROC曲线)分析UCSOM联合PLR对容量反应性的预测价值.结果 14例患者因无法获得满意的血流信号而终止试验.余下32例患者行容量负荷试验40例次,有反应组14例次,无反应组26例次.与PLR前比较,有容量反应性者PLR及VE后SV、心输出量(CO)均明显增加(P<0.01),外周血管阻力(SVR)明显下降(P<0.01),PLR及补液后中心静脉压(CVP)无明显变化(P>0.05);无容量反应性者PLR后SV有所增加(P<0.05),补液后SV无明显变化(P>0.05),PLR及VE后CO、SVR无明显变化(P>0.05),CVP均增加(P<0.05);PLR引起△SV与容量负荷试验引起△SV呈正相关(r=0.573,P=0.000).以△SVPLR预测容量反应性,AUCROC为0.948(0.886~1.000);以△SVPLR≥8.5%预测容量反应性其敏感性为100%,特异性为76.9%.结论当能够获取良好多普勒血流信号时,USCOM联合PLR测量△SV可用于预测老年脓毒症患者容量反应性.Objective To evaluate the ability of non-invasive ultrasonic cardiac output monitor(USCOM)combined with passive leg raising (PLR)test to predict volume responsiveness in elderly patients with sepsis. Methods 46 elderly patients with sepsis needed volume resuscitation in our ICU were selected from May 2015 to January 2018. Passive leg raising test(PLR)and volume expansion(VE)test were conducted successively. Based on the responsiveness of volume expansion〔It was considered to be responders to volume expansion if SV increased(△SVve)≥10%〕,all the patients were divided into responders and non-responders. The roles of PLR in predicting volume responsiveness were evaluated by receiver operating characteristic curve(ROC curve). Results There were 14 of the total 46 cases terminated the test because they were unable to obtain satisfactory blood flow signals. In the remaining 32 cases,a total of 40 PLR and VE tests were evaluated and resulted in 14 responders and 26 non-responders.In the responders,the SV and CO were significantly increased(P<0.01),the SVR were significantly decreased(P<0.01)after PLR and VE,the CVP had no significant changes after PLR and VE(P>0.05);In the nonresponders,the SV increased after PLR(P<0.05),but had no changes after VE(P>0.05). CO,SVR had no changes(P>0.05),and the CVP increased(P<0.05)after PLR and VE. Correlation analysis showed that there was the positive correlation between△SVPLR and △SVVE(r=0.573,P=0.000).The area under the ROC curve(AUC)of △SVPLR for PLR predicting volume responsiveness was 0.948. The △SVPLR≥8.5% was found to predict volume responsiveness with a sensitivity of 100% and specificity of 76.9%. Conclusion If fine Doppler signals can be obtained,USCOM combined with PLR can be used to predict volume responsiveness in elderly patients with sepsis.

关 键 词：USCOM无创心排血量监测 被动抬腿试验 容量反应性 老年 脓毒症 

分 类 号：R541.4[医药卫生—心血管疾病]