床旁超声评估下腔静脉呼吸变异度联合被动抬腿试验在重症脓毒症休克患者中的应用价值  

Application Value of Bedside Ultrasound in Evaluating Inferior Vena Cava Respiratory Variability Combined with Passive Leg Raising Test in Patients with Severe Septic Shock

作　　者：林宗钦 商益 菅洪健 江仁 LIN Zong-qin;SHANG Yi;JIAN Hong-jian;JIANG Ren(Department of ICU,Hui Ya Hospital of the First Affiliated Hospital,Sun Yat-Sun University,Huizhou 516081,Guangdong,China)

机构地区：[1]惠州市中大惠亚医院重症医学科,广东惠州516081

出　　处：《医学信息》2023年第17期142-145,共4页Journal of Medical Information

基　　金：惠州市科技计划项目(编号:210405214572779)。

摘　　要：目的探究床旁超声评估下腔静脉呼吸变异度(IVC-RVI)联合被动抬腿试验(PLR)在重症脓毒症休克(SS)患者中的应用价值。方法选取2019年1月-2022年6月惠州市中大惠亚医院重症医学科收治的64例重症SS患者,所有患者均给予液体负荷试验,依据液体负荷试验后心输出量变化率(△CO),分为VR组(△CO≥10%,n=30)与非VR组(△CO<10%,n=34),比较两组PLR后CO变化率(PLR-△CO)、IVC-RVI值,分析PLR、IVC-RVI与联合检测对患者容量反应性的预测价值。结果VR组的PLR-△CO、IVC-RVI值高于非VR组(P<0.05);Logistic回归分析显示,PLR-△CO、IVC-RVI均为容量反应性的独立预测因子(P<0.05);ROC曲线分析显示,IVC-RVI联合PLR-△CO值预测SS患者容量反应性的灵敏度与特异度大于二者单独检测(P<0.05)。结论床旁超声评估IVC-RVI联合PLR对重症SS患者容量反应性具有较高预测价值,可发挥补液指导作用。Objective To explore the application value of bedside ultrasound assessment of inferior vena cava respiratory variability(IVC-RVI)combined with passive leg raising test(PLR)in patients with severe septic shock(SS).Methods A total of 64 patients with severe SS admitted to the Department of ICU,Hui Ya Hospital of the First Affiliated Hospital,Sun Yat-Sun University from January 2019 to June 2022 were selected.All patients were given fluid load test.According to the change rate of cardiac output(△CO)after fluid load test,they were divided into VR group(△CO≥10%,n=30)and non-VR group(△CO<10%,n=34).The change rate of CO(PLR-△CO)and IVC-RVI values after PLR test were compared between the two groups,and the predictive value of PLR,IVC-RVI and combined detection for volume responsiveness of patients was analyzed.Results The values of PLR-△CO and IVC-RVI in the VR group were higher than those in the non-VR group(P<0.05).Logistic regression analysis showed that PLR-△CO and IVC-RVI were independent predictors of volume responsiveness(P<0.05).ROC curve analysis showed that the sensitivity and specificity of IVC-RVI combined with PLR-△CO value in predicting volume responsiveness of SS patients were greater than those of the two alone(P<0.05).Conclusion Bedside ultrasound evaluation of IVC-RVI combined with PLR has a high predictive value for volume responsiveness in patients with severe SS,which can play a guiding role in rehydration.

关 键 词：脓毒症休克 下腔静脉呼吸变异度 床旁超声 被动抬腿试验 容量反应性 

分 类 号：R459.7[医药卫生—急诊医学] R445.1[医药卫生—治疗学]