休克患者快速补液试验前后应用重症超声检测左室流出道速度时间积分及校正血流时间的临床意义  

Clinical significance of severe ultrasound detecting left ventricular outflow tract velocity-time integral and corrected flow time in shock patients before and after rapid fluid replacement test

作　　者：邵卫卫 彭文清 徐月文 SHAO Weiwei;PENG Wenqing;XU Yuewen(Department of Itensive Care Unitn,Xuancheng City Central Hospital,Xuancheng,Anhui,242000,China)

机构地区：[1]宣城市中心医院ICU,安徽宣城242000

出　　处：《临床急诊杂志》2023年第1期6-10,共5页Journal of Clinical Emergency

摘　　要：目的:探讨休克患者快速补液试验前后应用重症超声检测左室流出道速度时间积分(VTI)及校正血流时间(FTc)的临床意义。方法:选择我院2020年1月—2022年3月80例休克患者作为研究对象,均行快速补液试验,试验前后应用重症超声检测每搏量(SV)、VTI及FTc,定义试验前后SV增加值(ΔSV)<15%为无容量反应性,根据容量反应情况将80例患者分为无反应组(n=34)及有反应组(n=46),检测血流动力学指标,分析其与ΔSV的相关性,采用受试者工作特征曲线(ROC)评估ΔVTI、ΔFTc对容量反应性的预测价值。结果:有反应组快速补液试验后SV、VTI及FTc均高于快速补液试验前(P<0.05);有反应组快速补液试验后ΔSV、ΔVTI、ΔFTc均高于无反应组(P<0.05);Pearson相关性分析显示,快速补液试验前后ΔVTI、ΔFTc与ΔSV均呈正相关(P<0.05);由ROC曲线可知,休克患者快速补液试验前后ΔVTI、ΔFTc联合预测容量反应性的AUC为0.925,高于两者单独预测的0.848、0.812(P<0.05)。结论:重症超声检测快速补液试验引起的VTI和FTc变化(ΔVTI、ΔFTc),能准确预测休克患者的容量反应性,可作为指导容量治疗的参考指标。Objective: To explore the clinical significance of severe ultrasound detecting left ventricular outflow tract velocity-time integral(VTI) and corrected flow time(FTc) in shock patients before and after rapid fluid replacement test. Methods: A total of 80 patients with shock in the hospital from January 2020 to March 2022 were enrolled as the research objects. All of them underwent rapid fluid rehydration test. Stroke volume(SV), VTI and FTc were detected by severe ultrasound before and after the test. The increment of SV(ΔSV) <15% before and after the test was defined as volume non-responsiveness. According to volume responsiveness, the 80 patients were divided into non-responsiveness group(n=34) and responsiveness group(n=46). The hemodynamics indexes between the two groups were compared before and after the test. The correlation between ultrasound indexes and ΔSV was analyzed by Pearson coefficient. The predictive value of ΔVTI and ΔFTc for volume responsiveness was evaluated by receiver operating characteristic(ROC) curves. Results: After rapid fluid replacement test, SV, VTI and FTc were increased in responsiveness group(P<0.05). After rapid fluid replacement test, ΔSV, ΔVTI and ΔFTc were increased in responsiveness group(P<0.05). Pearson correlation analysis showed that ΔVTI and ΔFTc were positively correlated with ΔSV before and after the test(P<0.05). ROC curves analysis showed that AUC of ΔVTI combined with ΔFTc for predicting volume responsiveness before and after rapid fluid rehydration test was 0.925, which was higher than 0.848 and 0.812 predicted by them alone(P<0.05). Conclusion: The changes of VTI and FTc(ΔVTI, ΔFTc) induced by rapid fluid replacement test detected by severe ultrasound can accurately predict the volume responsiveness in shock patients, and can be applied as a reference index to guide volumetric therapy.

关 键 词：休克 快速补液试验 重症超声 左室流出道速度时间积分 校正血流时间 容量反应性 

分 类 号：R631.2[医药卫生—外科学]