微剂量容量负荷试验联合主动脉速度时间积分对脓毒性休克患者容量反应性的预测价值  

The value of the Mini-fluid challenge combined with Aortic velocity time integral predicts fluid responsiveness in septic shock patients

作　　者：吴翔 陶飞 娄侠儒 吴晓弟 许瑞玉 WU Xiang;TAO Fei;LOU Xia-ru(Intensive Care Unit,Foshan Fosun Chancheng Hospital,Foshan 528031,China)

机构地区：[1]佛山复星禅诚医院重症医学科,广东佛山528031

出　　处：《中国处方药》2022年第11期138-141,共4页Journal of China Prescription Drug

基　　金：佛山市医学类科技攻关项目(1920001001416);佛山市“十四五”医学培育专科项目(FSPY145021)。

摘　　要：目的探讨微剂量容量负荷试验联合主动脉速度时间积分(VTI)对脓毒性休克患者容量反应性的预测价值。方法采用前瞻性观察性队列研究方法,选择2020年1月~2021年12月佛山复星禅诚医院重症医学科收治的72例脓毒性休克患者作为研究对象,所有患者均给予常规治疗。将0.9%氯化钠注射液50 ml经中心静脉在10 s内快速推注完毕,立即使用经胸超声心动图(TTE)进行床旁心排量监测,并记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、每搏量(SV)、心输出量(CO)等参数,时间点标注为T50;而后在29 min内将剩余的0.9%氯化钠注射液450 ml输注完毕,再次使用TTE测量上述参数,时间点标注为T500。容量反应性定义为输注500 ml晶体液后患者SV增加≥15%(ΔSV500),并据此将患者分为有反应组和无反应组。比较容量负荷试验前后的血流动力学指标,分析ΔSV50与ΔSV500的相关性;ΔSV50的敏感性与特异性则用受试者工作特征(ROC)曲线进行分析。结果本研究共纳入脓毒性休克患者72例,其中有反应组40例(55.56%),无反应组32例(44.45%)。在接受50ml及500 ml容量负荷试验后,容量有反应组患者的VTI、SV、CO明显增加(P<0.05),而MAP、CVP的变化无明显差异(P>0.05);在500 ml容量负荷试验后,容量无反应组的CVP明显增加(P<0.05),而MAP、SV、CO等指标前后比较无明显变化(P>0.05)。ΔSV50与ΔSV500呈正相关性(r=0.675,P<0.01),ΔSV50预测容量反应性的ROC曲线下面积为0.944(95%CI:0.897~0.940,P=0.000),以ΔSV50≥7.6%为最佳截断值,灵敏度为84.8%,特异度为81.0%。结论微剂量容量负荷试验联合VTI可预测脓毒性休克患者的容量反应性,与传统容量负荷试验相比较有良好的相关性。Objective To investigate the value of the mini-fluid challenge predicts fluid responsiveness in septic shock patients.Methods A prospective observational cohort study was conducted.Seventy-two mechanically ventilated patients with septic shock admitted to Department of Intensive Care Unit of Foshan FOSUN Chancheng Hospital from January 2020 to December 2021 were enrolled.All patients were given routine treatment.A total of 50 ml of 0.9%sodium chloride injection was injected rapidly through central venous catheterization in 10 seconds to completemini fluid challenge.The remaining 450 ml was injected in 29 minutes to complete the classical fluid challenge.The hemodynamic parameters,including aortic velocity time integral(VTI)and stroke volume(SV),cardiac output(CO)before mini fluid challenge(basic level);After fluid challenge,immediately examined by echocardiography,and the central venous pressure(CVP),mean arterial pressure(MAP)was monitored.Fluid responsiveness was defined as an increase of SV after 500 ml volume expansion(ΔSV500)≥15%.The patients were separated into positive group and negative group.The relevance betweenΔSV50 andΔSV500 was analyzed,the sensitivity and specificity of the△SV50 were analyzed by receiver operating characteristic(ROC)curve.Results A total of 72 patients were included in the study,of which 40 cases(55.56%)were responders,and 32 cases(44.45%)were nonresponders.After 50 ml fluid challenge was performed,the VTI,SV and CO of responders group had increased significantly(P<0.05)which was in accord with that after a further 500 ml fluid challenge.But there was no significant difference in the changes in CVP after 50 ml and 500 ml fluid challenge.After 500 ml fluid challenge was performed,the CVP of nonresponders group had increased significantly(P<0.05)but there was no significant difference in the changes in MAP,VTI,SV,CO after 50 ml and 500 ml fluid challenge,ΔSV50 andΔSV500 were strongly correlated(r=0.675,P<0.01).The area under ROC curve forΔSV50 was 0.944(95%CI:0.897~0.940,P=0

关 键 词：微剂量容量负荷试验 主动脉速度时间积分 容量反应性 脓毒性休克 

分 类 号：R459.7[医药卫生—急诊医学]