脉压变异对脓毒性休克患者容量复苏的指导作用  

Guiding role of pulse pressure variability in volume resuscitation of patientswith septic shock and its correlation with volume response

作　　者：张婷[1] 李灿 邹帅[1] 刘亚林[1] 杨锦平 余娜 陈莹 陈钇然 ZHANG Ting;LI Can;ZOU Shuai;LIU Yalin;YANG Jinping;YU Na;CHEN Ying;CHEN Yiran(Department of Critical Medicine,Chongqing Fifth People′s Hospital,Chongqing 400062,China)

机构地区：[1]重庆市第五人民医院重症医学科,重庆400062

出　　处：《国际检验医学杂志》2023年第10期1177-1180,共4页International Journal of Laboratory Medicine

基　　金：重庆市南岸区卫生和计划生育委员会科研项目(2018-20)。

摘　　要：目的 探讨脉压变异度(PPV)在脓毒性休克患者容量复苏治疗中的指导作用及与容量反应的相关性。方法 将2018年4月至2021年4月该院收治的脓毒性休克患者90例分为对照组及观察组,每组45例。对照组采用中心静脉压(CVP)指导液体复苏,观察组采用PPV指导液体复苏。比较两组患者的复苏效果,包括平均动脉压(MAP)、心率(HR)、氧合指数[动脉血氧分压(PaO_(2))/吸入氧浓度(FiO_(2))]、PPV、乳酸、CVP、6 h液体平衡量、肺水肿比例、ICU住院时间、28 d病死率,同时分析PPV、CVP预测脓毒性休克患者容量反应性效能。结果 两组患者组内多时间点、组间多时间点MAP、HR、PaO_(2)/FiO_(2)比较,差异有统计学意义(P<0.05);治疗后两组患者MAP、PaO_(2)/FiO_(2)显著高于治疗前(P<0.05),HR显著低于治疗前(P<0.05);治疗后24 h,观察组MAP、PaO_(2)/FiO_(2)显著高于对照组(P<0.05),HR显著低于对照组(P<0.05)。两组患者组内多时间点、组间多时间点PPV、乳酸、CVP比较,差异有统计学意义(P<0.05);治疗后两组患者PPV、乳酸均显著降低(P<0.05),CVP均显著升高(P<0.05);治疗后24 h,观察组患者PPV、乳酸水平显著低于对照组(P<0.05),CVP水平显著低于对照组(P<0.05)。受试者工作特征(ROC)曲线分析显示,PPV预测脓毒性休克患者容量反应性的ROC曲线下面积为0.763,高于CVP的0.672,PPV预测脓毒性休克患者容量反应性效能优于CVP(P<0.05)。两组预后情况比较,观察组6 h液体平衡量显著高于对照组,肺水肿比例、ICU住院时间显著低于或短于对照组,差异均有统计学意义(P<0.05)。结论 PPV及CVP均能指导脓毒性休克患者液体复苏,PPV对指导脓毒性休克患者液体复苏具有更高的准确性。Objective To explore the guiding role of pulse pressure variation(PPV)in volume resuscitation of septic shock patients and its correlation with volume response.Methods Totally 90 patients with septic shock in our hospital from April 2018 to April 2021 were selected and randomly divided into control group and observation group,45 cases in each group.The control group used central venous pressure(CVP)to guide fluid resuscitation,and the observation group used PPV to guide fluid resuscitation.The effects of resuscitation were compared between the two groups,including mean arterial pressure(MAP),heart rate(HR),oxygenation index(PaO_(2)/FiO_(2)),PPV,lactic acid,CVP,6-hour fluid balance volume,pulmonary edema ratio,time of stay in ICU and 28-day mortality rate.At the same time,PPV and CVP were used to predict volume responsiveness in septic shock patients.Results There were statistically significant differences in MAP,HR,PaO_(2)/FiO_(2) at multiple time points within and between the two groups(P<0.05).After treatment,MAP,PaO_(2)/FiO_(2) in the two groups were significantly higher than before treatment(P<0.05),and HR was significantly lower than before treatment(P<0.05).Twenty-four hours after treatment,MAP,PaO_(2)/FiO_(2) in the observation group were significantly higher than those in the control group(P<0.05),and HR in the observation group was significantly lower than that in the control group(P<0.05).There were statistically significant differences in PPV,lactic acid and CVP at multiple time points within and between the two groups(P<0.05).After treatment,PPV and lactic acid were significantly decreased in the two groups(P<0.05),and CVP was significantly increased in two groups(P<0.05).Twenty-four hours after treatment,PPV and lactic acid levels in observation group were significantly lower than those in control group(P<0.05),and CVP was significantly lower than that in control group(P<0.05).The ROC curve analysis showed that the area under ROC curve of PPV was 0.763,which was higher than that of CVP(0.672),indicat

关 键 词：脉压变异度 中心静脉压 容量反应性 脓毒性休克 

分 类 号：R459.7[医药卫生—急诊医学]