3种功能性血流动力学监测方法在预测感染性休克患者容量反应性中的价值分析  

Three functional hemodynamic monitoring methods in predicting volume responsiveness in patients with septic shock

作　　者：任思思[1] 杜乃东 刘岩[1] REN Si-si;DU Nai-dong;LIU Yan(Department of Intensive Care Medicine,Tianjin Beichen Hospital,Tianjin 300400,China)

机构地区：[1]天津市北辰医院重症医学科,天津300400

出　　处：《广东医学》2020年第7期708-712,共5页Guangdong Medical Journal

基　　金：天津市北辰区科技发展计划项目(2018-SHGY-18)。

摘　　要：目的探讨三种功能性血流动力学监测方法在预测感染性休克患者容量反应性中的价值。方法选择重症医学科收治的感染性休克患者70例。所有患者依次采用呼气末阻断试验(EEO)、被动直腿抬高试验(PLR)和容量负荷试验(VE)。采用PICCO持续监测患者的每搏输出量(SV)、心脏指数(CI)、脉压(PP)等血流动力学指标变化,以VE试验前后CI变异(ΔCIVE)≥15%定义为容量反应性阳性,分析PLR和EEO各血流动力学指标预测容量反应性的敏感度、特异度,并绘制受试者工作特征(ROC)曲线。结果 70例患者中容量反应性阳性42例,阴性28例。容量反应性阳性患者中ΔCIEEO、ΔCOEEO、ΔPPEEO、ΔSBPEEO、ΔMAPEEO、ΔCOPLR、ΔSVPLR、ΔPETCO2PLR与ΔCIVE呈正相关(P<0.05)。以ΔCIEEO≥5%预测ΔCIVE≥15%的ROC曲线下面积(AUC)为0.921,敏感度为88.10%,特异度为85.71%;以ΔPPEEO≥4%预测ΔCIVE≥15%的AUC为0.945,敏感度为93.02%,特异度为85.19%;以SVPLR≥8%预测ΔCIVE≥15%的AUC为0.912,敏感度为91.81%,特异度为88.07%;以ΔPETCO2PLR≥13%预测ΔCIVE≥15%的AUC为0.960,敏感度为97.50%,特异度为86.67%。结论 PLR试验前后SV、PETCO2变异水平和EEO试验前后PP、CI变异水平预测感染性休克患者容量反应性具有较高敏感度和特异度。Objective To investigate the value of 3 functional hemodynamic monitoring methods in predicting the volume responsiveness of patients with septic shock. Methods Seventy patients with septic shock admitted to the Department of Critical Care Medicine were enrolled. All patients received end-expiratory block(EEO), passive straight-leg elevation test(PLR), and volumetric load test(VE). PICCO was applied for continuous monitoring of hemodynamic parameters, including stroke volume(SV), cardiac index(CI) and pulse pressure(PP). The CI mutation(ΔCIVE) ≥15% before and after VE was defined as volume response. The sensitivity and specificity of the hemodynamic parameters of PLR and EEP in predicting volume reactivity were analyzed, and the receiver operating characteristic curve was conducted. Results Of the 70 patients, 42 were positive for volume response and 28 were negative. In patients with positive volume reactivity, ΔCIEEO, ΔCOEEO, ΔPPEEO, ΔSBPEEO, ΔMAPEEO, ΔCOPLR and ΔSVPLR were positively correlated with ΔCIVE. The area under the ROC curve(AUC) with ΔCIEEO≥5% as threshold in predicting ΔCIVE≥15% was 0.921, with the sensitivity of 88.10% and the specificity of 85.71%. The AUC with ΔPPEEO≥4% as threshold in predicting ΔCIVE≥15% was 0.945, with the sensitivity of 93.02% and the specificity of 85.19%. The AUC with ΔCIVE≥15% as threshold in predicting ΔSVPLR≥8% was 0.912, with the sensitivity of 91.81% and the specificity of 88.07%. The AUC with PETCO2 PLR≥13% as threshold in predicting ΔCIVE≥15% was 0.960, with the sensitivity of 97.50% and the specificity of 86.67%. Conclusion The levels of SV and PETCO2 before and after PLR test, and the levels of PP and CI before and after EEO test can predict the volume sensitivity of patients with septic shock with high sensitivity and specificity.

关 键 词：感染性休克 容量反应性 呼气末阻断试验 被动直腿抬高试验 容量负荷试验 

分 类 号：R4438[医药卫生—诊断学] R441.9[医药卫生—临床医学]