基于下腔静脉相关指标及其变异性对脓毒症休克液体复苏效果预测价值分析  

Analysis of the predictive value of inferior vena cava related indicators and their variability for fluid resuscitation in septic shock

作　　者：王平[1] 李辉[1] 苑晓姣 刘燕[1] 郭元竞 迪力夏提·阿力甫 Wang Ping;Li Hui;Yuan Xiaojiao;Liu Yan;Guo Yuanjing;Dilixiati Alifu(Department of Critical Care Medicine,Xinjiang Production and Construction Corps Hospital,Xinjiang Province,Urumqi 830002,China)

机构地区：[1]新疆生产建设兵团医院重症医学科,乌鲁木齐830002

出　　处：《疑难病杂志》2023年第5期505-509,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：新疆生产建设兵团科技攻关项目(2018AB024)。

摘　　要：目的分析下腔静脉相关指标及其变异性对脓毒症休克液体复苏效果的预测价值。方法选取2021年1月—2022年3月新疆生产建设兵团医院ICU病房收治脓毒症休克患者109例,均予患者补液、抗感染等规范化治疗,根据28 d内患者是否死亡分为存活组69例和死亡组40例,比较2组患者临床资料,复苏前及复苏6 h后的平均动脉压(MAP)、中心静脉压(CVP)、下腔静脉(IVC)直径、IVC扩张指数及相关指标变异性,采用多因素Cox回归模型分析脓毒症休克患者预后的影响因素,并绘制受试者工作特征曲线(ROC)评估脓毒症患者预后影响因素的诊断价值。结果死亡组患者APACHEⅡ评分高于存活组(t/P=3.714/0.002)。治疗前死亡组MAP、CVP、IVC直径均低于存活组,而IVC扩张指数高于存活组(t/P=6.505/<0.001,2.062/0.042,2.943/0.004,6.383/<0.001);治疗6 h后2组患者MAP、CVP及IVC直径均升高,IVC扩张指数均降低,且死亡组MAP低于存活组,IVC扩张指数高于存活组(t/P=12.196/<0.001,14.478/<0.001);死亡组患者MAP变异性、CVP变异性均高于存活组(t/P=8.873/<0.001,7.355/<0.001);多因素Cox回归分析显示,MAP变异性高、CVP变异性高、治疗前IVC扩张指数高及治疗6 h后IVC扩张指数高是影响患者预后的独立危险因素[HR(95%CI)=1.465(1.179~1.819)、1.133(1.034~1.240)、1.142(1.007~1.295)、1.278(1.025~1.593)];ROC曲线结果显示,MAP变异性、CVP变异性、治疗前IVC扩张指数、治疗6 h后IVC扩张指数及四者联合预测脓毒症休克患者复苏效果的曲线下面积(AUC)分别为0.929、0.862、0.790、0.862、0.985,四者联合优于各自单独预测效能(Z/P=2.334/0.020、3.579/<0.001、4.602/<0.001、2.970/0.003)。结论治疗前后IVC扩张指数联合预测脓毒症休克患者预后具有较高的特异度及敏感度,可作为临床观察指标用于监测患者病情变化及预后。Objective To analyze the predictive value of inferior vena cava related indicators and their variability for the effectiveness of fluid resuscitation in septic shock.Methods A total of 109 patients with septic shock admitted to the ICU Ward of Xinjiang Production and Construction Corps Hospital from January 2021 to March 2022 were selected,all of whom received standardized treatment such as fluid replacement and anti-infection.According to whether the patients died within 28 days,they were divided into a survival group of 69 cases and a death group of 40 cases.The clinical data of the two groups of patients were compared,including average arterial pressure(MAP),central venous pressure(CVP),inferior vena cava(IVC)diameter before and 6 hours after resuscitation The variability of IVC dilation index and related indicators was analyzed using a multivariate Cox regression model to analyze the influencing factors of prognosis in septic shock patients,and the diagnostic value of the influencing factors of prognosis in septic shock patients was evaluated by drawing a receiver operating characteristic curve(ROC).Results The APACHE II score of patients in the death group was higher than that in the survival group(t/P=3.714/0.002).Before treatment,the MAP,CVP,and IVC diameter of the death group were lower than those of the survival group,while the IVC dilation index was higher than that of the survival group(t/P=6.505/<0.001,2.062/0.042,2.943/0.004,6.383/<0.001);After 6 hours of treatment,the MAP,CVP,and IVC diameter of both groups of patients increased,while the IVC dilation index decreased.The MAP of the death group was lower than that of the survival group,and the IVC dilation index was higher than that of the survival group(t/P=12.196/<0.001,14.478/<0.001);The MAP variability and CVP variability of patients in the death group were higher than those in the survival group(t/P=8.873/<0.001,7.355/<0.001);Multivariate Cox regression analysis showed that high MAP variability,high CVP variability,high ICV dilation index before

关 键 词：脓毒症休克 下腔静脉相关指标 液体复苏 

分 类 号：R631.2[医药卫生—外科学] R631.4[医药卫生—临床医学]