肺部超声指标和脉搏指示剂连续心排出量监测指标预测脓毒症休克合并心肌抑制患者容量反应性的准确性比较  

Comparison of the accuracy of pulmonary ultrasound index and pulse indicator continuous cardiac output monitoring(PiCCO)in predicting volume responsiveness in patients with septic shock complicated with myocardial depression

作　　者：李经毅 贠沙沙 朱志德 LI Jingyi;YUN Shasha;ZHU Zhide(Affiliated Huidong Hospital of Guangdong Medical University,Guangdong,Huidong 516300,China)

机构地区：[1]广东医科大学附属惠东医院,广东惠东516300

出　　处：《中国医药科学》2022年第1期179-182,共4页China Medicine And Pharmacy

基　　金：广东省惠州市医疗卫生类科技计划项目(2020Y350)。

摘　　要：目的比较肺部超声指标和脉搏指示剂连续心排出量监测(PiCCO)指标预测脓毒症休克合并心肌抑制患者容量反应性的准确性。方法选取广东医科大学附属惠东医院2019年10月至2020年10月诊治的100例脓毒症休克合并心肌抑制患者开展本研究,补液试验方法为采取500 ml乳酸林格液注射液或0.9%氯化钠注射为患者进行快速静脉输注,补液前对100例患者均进行肺部超声检测和PiCCO,根据监测结果将其划分为容量反应阴性组55例和容量反应阳性组45例,分析比较两组PiCCO指标、肺部超声指标监测效果以及肺部超声和PiCCO指标容量反应性的ROC曲线结果。结果容量反应阳性组的胸腔内血容量指数、全心舒张末期容积、肺血管通透性指数、血管外肺水指数和每分钟冲程量准确性均高于容量反应阴性组,差异有统计学意义(P<0.05);容量反应阳性组的单侧前胸壁呈B线占比、双侧前胸壁呈B线占比和肺部超声评分均低于容量反应阴性组,差异有统计学意义(P<0.05);容量反应性ROC曲线结果为肺血管通透性指数指标、血管外肺水指数指标和肺部超声评分的灵敏度分别为91%、83%和87%,特异度分别为52%、71%和71%。结论在脓毒症休克合并心肌抑制患者的容量反应性预测工作中应用PiCCO和肺部超声指标均能获得较高的准确性,同时检查安全性高,具有推广价值。Objective To compare the accuracy of pulmonary ultrasound index and pulse indicator continuous cardiac output monitoring(PiCCO)index in predicting volume responsiveness in patients with septic shock and myocardial depression.Methods A total of 100 patients with septic shock complicated with myocardial depression treated in Affiliated Huidong Hospital of Guangdong Medical University from October 2019 to October 2020 were selected to carry out this experimental study.The rehydration experiment method was to take 500 ml Ringer lactate injection or 0.9%sodium chloride injection for rapid intravenous infusion.Before rehydration,all 100 patients were examined by pulmonary ultrasound and monitored by PiCCO.According to the monitoring results,the patients were divided into negative volume response group(n=55)and positive volume response group(n=45).The monitoring effects of PiCCO index,pulmonary ultrasound index and ROC curve results of lung ultrasound and volume responsiveness of PiCCO index were analyzed and compared between the two groups.Results The accuracy of chest blood volume index,whole heart end diastolic volume index,pulmonary vascular permeability index,extravascular lung water index and stroke volume per minute index in positive volume response group were higher than those in negative volume response group,with statistically significant differences(P<0.05).B-line ratio of unilateral chest wall,B-line ratio of bilateral chest wall and ultrasound score of lung in positive volume response group were lower than those in negative volume response group,with statistically significant differences(P<0.05).The results of volume response ROC curve showed that the sensitivity of pulmonary vascular permeability index,extravascular pulmonary water index and pulmonary ultrasound score were 91%,83%and 87%respectively,and the specificity were 52%,71%and 71%respectively.Conclusion The application of PiCCO and pulmonary ultrasound indicators can obtain high accuracy in predicting volume responsiveness in patients with septic s

关 键 词：肺部超声 PICCO 脓毒症休克 心肌抑制 容量反应性 准确性 

分 类 号：R459.7[医药卫生—急诊医学]