无创超声检测每搏量变异度、心脏指数联合被动抬腿试验对脓毒性休克患者容量反应性的预测价值  

Predictive value of stroke volume variation and Cardiac Index by non-invasive ultrasound combined with passive leg raising for volume responsiveness in patients with septic shock

作　　者：赵霞 贾绍茂 郑涛[1] 卢元明 ZHAO Xia;JIA Shaomao;ZHENG Tao;LU Yuanming(Department of Critical Care Medicine,the First People’s Hospital of Guangyuan,Guangyuan 628017,China)

机构地区：[1]广元市第一人民医院重症医学科,四川广元628017

出　　处：《陕西医学杂志》2023年第6期701-704,共4页Shaanxi Medical Journal

基　　金：四川省科技计划项目(2019YJ0702)。

摘　　要：目的:探讨无创超声检测每搏量变异度(SVV)、心脏指数(CI)联合被动抬腿试验(PLR)对脓毒性休克(SS)患者容量反应性的预测价值。方法:选取SS患者82例为研究对象,均行PLR。定义PLR前后心输出量增加率(ΔCO)<15%为无容量反应性,根据容量反应情况将患者分为无反应组(32例)及有反应组(50例)。无创超声检测PLR前后SVV、CI。采用Pearson法分析PLR前后SVV减少值(ΔSVV)、CI增加值(ΔCI)与ΔCO的相关性。采用受试者工作特征(ROC)曲线评估ΔSVV、ΔCI对SS患者容量反应性的预测价值。结果:PLR后,有反应组SVV低于PLR前,CI、CO高于PLR前(均P<0.05)。有反应组PLR后ΔSVV、ΔCI、ΔCO高于无反应组(均P<0.05)。Pearson相关性分析显示,PLR前后ΔSVV、ΔCI与ΔCO呈正相关(r=0.741、0.698,均P<0.05)。由ROC曲线可知,SS患者PLR前后ΔSVV、ΔCI联合预测容量反应性的AUC为0.915,高于两者单独预测的0.804、0.812(均P<0.05)。结论:无创超声检测SVV、CI联合PLR可以准确预测SS患者容量反应性。Objective:To explore the predictive value of stroke volume variation(SVV)and Cardiac Index(CI)combined with passive leg raising(PLR)for volume responsiveness in patients with septic shock(SS).Methods:A total of 82 patients with SS were enrolled as the research objects.All were tested by PLR.If increment rate of cardiac output(ΔCO)<15%before and after PLR,there was no volume responsiveness.According to presence or absence of volume responsiveness,they were divided into non-responsiveness group(32 case)and responsiveness group(50 cases).SVV and CI were detected by non-invasive ultrasound before and after PLR.The correlation between SVV reduction(ΔSVV),CI increment(ΔCI)andΔCO was analyzed by Pearson method.The predictive value ofΔSVV andΔCI for volume responsiveness in SS patients was evaluated by ROC curve.Results:After PLR,SVV was decreased,while CI and CO were increased in responsiveness group(all P<0.05).After PLR,ΔSVV,ΔCI andΔCO in responsiveness group were higher than those in non-responsiveness group(all P<0.05).Pearson correlation analysis showed thatΔSVV andΔCI were positively correlated withΔCO(r=0.741、0.698,all P<0.05).ROC curve analysis showed that AUC ofΔSVV combined withΔCI for predicting volume responsiveness was 0.915,greater than that of single index(0.804,0.812,all P<0.05).Conclusion:SVV and CI by non-invasive ultrasound combined with PLR can accurately predict volume responsiveness in SS patients.

关 键 词：脓毒性休克 无创超声 每搏量变异度 心脏指数 容量反应性 被动抬腿试验 心输出量 

分 类 号：R459.7[医药卫生—急诊医学]