超声联合小剂量容量负荷试验评估感染性休克患者容量反应性的临床价值  

Value of ultrasound combined with low-dose volumetric load testing in evaluating volumetric responsiveness in patients with septic shock

作　　者：秦毅 巩亚婷 冯晶 魏婷婷 QIN Yi;GONG Ya-ting;FENG Jing(Department of Intensive Care,Air Force 986 Hospital,Xi'an Shaanxi 710054,China.;Department of General Practice,Air Force 986 Hospital,Xi'an Shaanxi 710054,China.)

机构地区：[1]空军第986医院重症医学科,陕西西安710054 [2]空军第986医院全科医学科,陕西西安710054

出　　处：《临床和实验医学杂志》2022年第19期2059-2062,共4页Journal of Clinical and Experimental Medicine

基　　金：2019年度军队医学科技青年培育计划课题(编号:19QNPO28)。

摘　　要：目的探讨超声联合小剂量容量负荷试验评估感染性休克患者容量反应性的临床价值。方法回顾性选取2017年2月至2022年2月空军第986医院收治的感染性休克患者80例,依据快速输注500 mL晶体液后超声检测的心排血量(CO)增加量(△CO500)分为容量反应组(△CO500≥15%)、容量无反应组(△CO500<15%)两组,每组各40例。比较两组者患者试验前、试验中、试验后的血流动力学参数,分析△CO500与血流动力学参数相关性,并比较两组患者的临床指标。结果试验前,容量反应组患者的CO、主动脉速度时间积分(VTI)均明显低于容量无反应组,差异均有统计学意义(P<0.05),但两组患者的心率、中心静脉压(CVP)、平均动脉压(MAP)、左室射血分数(LVEF)之间差异均无统计学意义(P>0.05);试验中,容量反应组患者的CVP、CO、VTI均明显低于容量无反应组,差异均有统计学意义(P<0.05),但两组患者的心率、MAP、LVEF比较,差异均无统计学意义(P>0.05);试验后,容量反应组患者的CVP明显低于容量无反应组,LVEF明显高于容量无反应组,差异均有统计学意义(P<0.05),但两组患者的心率、MAP、CO、VTI比较,差异均无统计学意义(P>0.05)。两组患者试验前、试验中、试验后的心率均逐渐降低,CVP、MAP、CO、LVEF、VTI均逐渐升高,差异均有统计学意义(P<0.05)。△CO500与心率、CVP、MAP均无相关性(P>0.05)。容量反应组患者的丙泊酚维持使用时间明显短于容量无反应组,机械通气时间明显短于容量无反应组,差异均有统计学意义(P<0.05),但两组患者的去甲肾上腺素用量、氧合指数、总PEEP、潮气量之间差异均无统计学意义(P>0.05)。结论超声联合中小剂量容量负荷试验联合评估感染性休克患者容量反应性有较高的临床价值,有助于稳定血流动力学指标,缩短丙泊酚维持使用时间和机械通气时间。Objective To explore the clinical value of ultrasound combined with low-dose volume stress test in evaluating volume responsiveness in patients with septic shock.Methods A total of 80 patients with septic shock in Air Force 986 Hospital from February 2017 to February 2022 were selected retrospectively.According to the increase of cardiac output(CO)(△CO500)after rapid infusion of 500 mL crystal fluid,they were divided into volume response group(△CO500≥15%)and volume non-response group(△CO500<15%)two groups,40 cases in each group,hemodynamic parameters before the experiment,during the experiment,after the experiment of the two groups were analyzed,the correlation between△CO500 and hemodynamic parameters were analyzed,and clinical indicators of the two groups were statistically analyzed.Results Before the experiment,CO and aortic velocity time integral(VTI)in volume response group were lower than those in volume non-response group,the differences were statistically significant(P<0.05),but there were no significant differences in heart rate,central venous pressure(CVP),mean arterial pressure(MAP),left ventricular ejection fraction(LVEF)between 2 groups(P>0.05).During the experiment,CVP,CO and VTI in volume response group were lower than those in volume non-response group,the differences were statistically significant(P<0.05),but there were no significant differences in heart rate,MAP and LVEF between 2 groups(P>0.05).After the experiment,CVP in volume response group was lower than that in volume non-response group,LVEF was higher than that of volume-free group,the differences were statistically significant(P<0.05),but there were no significant differences in heart rate,MAP,CO and VTI between 2 groups(P>0.05).Heart rate in 2 groups decreased gradually before,during and after the experiment,CVP,MAP,CO,LVEF and VTI increased gradually(P<0.05).There was no correlation between△CO500 and heart rate,CVP,MAP(P>0.05).Propofol maintenance time was shorter in the volume-response group than in the volume-non-response

关 键 词：感染性休克 容量反应性 超声 小剂量容量负荷试验 血流动力学 

分 类 号：R459.7[医药卫生—急诊医学]