中心静脉血氧饱和度、下腔静脉呼吸变异指数对脓毒症休克机械通气患者容量反应有评估作用  

Central venous oxygen saturation and inferior vena cava respiratory variability index for evaluation of volume response in septic shock patients undergoing mechanical ventilation

作　　者：杨金连 杨鑫 杜文杰[1] YANG Jin-lian;YANG Xin;DU Wen-jie(Intensive Care Medicine,People's Hospital of Bozhou,Anhui Bozhou 236800,China)

机构地区：[1]亳州市人民医院重症医学科,安徽亳州236800

出　　处：《内科急危重症杂志》2023年第4期301-303,323,共4页Journal of Critical Care In Internal Medicine

摘　　要：目的:评估中心静脉血氧饱和度(ScvO_(2))、下腔静脉呼吸变异指数(IVC-rvi)对脓毒症休克机械通气患者容量反应的价值,分析其与乳酸清除率(LCR)的相关性。方法:回顾性分析78例脓毒症休克患者的临床资料,患者均进行机械通气与容量负荷试验。根据心脏指数(CI)分为有反应组37例(CI≥15%)和无反应组41例(CI<15%),分析负荷试验前、后ScvO_(2)、IVC-rci、LCR情况,绘制受试者工作特征(ROC)曲线,评估ScvO_(2)、IVC-rci对负荷试验有反应者的预测价值。采用Pearson相关性分析LCR与ScvO_(2)、IVC-rvi的相关性。结果:有反应组负荷前、后ScvO_(2)、乳酸低于无反应组,IVC-rvi高于无反应组(P均<0.05)。ROC曲线分析显示,ScvO_(2)、IVC-rvi预测有反应患者的AUC为0.617、0.741;两项联合预测AUC为0.864,灵敏度91.9%,特异性78.0%。Pearson相关性分析显示LCR与ScvO_(2)、IVC-rvi呈显著正相关(r=0.526、0.541,P均<0.05)。结论:ScvO_(2)、IVC-rvi对预测脓毒症休克机械通气患者容量反应具有一定价值,但两者联合预测效果更好,且两指标与LCR存在明显相关性。Objective:To study the value of central venous oxygen saturation(ScvO_(2))and inferior vena cava respiratory variability index(IVC-rvi)in assessing the volume response of septic shock patients undergoing mechanical ventilation,and analyze their correlation with lactate clearance(LCR).Methods A retrospective analysis was performed on the clinical data of 78 patients with septic shock,all of whom underwent mechanical ventilation and volume load testing.According to the cardiac index(CI),37 cases served as a responsive group(CI≥15%)and 41 cases as an unresponsive group(CI<15%).ScvO_(2),IVC-rvi,and LCR were analyzed before and after the load test,and the receiver operating characteristic(ROC)curve of the subjects was drawn to analyze the predictive value of ScvO_(2),IVC-rvi for responders in the load test.Pearson correlation analysis was used to investigate the correlation between LCR and ScvO_(2),IVC-rvi.Results:The ScvO_(2)and lactate levels in the responsive group before and after loading were lower than those in the unresponsive group(P<0.05).IVC-rvi in the responsive group was higher than that in the unresponsive group(P<0.05).The ROC curve analysis showed that the area under the curve(AUC)predicted by ScvO_(2)and IVC-rvi was 0.617 and 0.741 for the responsive patients,and that by both ScvO_(2)and IVC-rvi was 0.864,with sensitivity of 91.9%and specificity of 78.0%.Pearson correlation analysis showed a significant positive correlation between LCR and ScvO_(2),IVC-rvi(r=0.526,0.541,P<0.05).Conclusion:ScvO_(2)and IVC-rvi have certain value in predicting volume response in septic shock patients undergoing mechanical ventilation,but the prediction effect of combined ScvO_(2)and IVC-rvi is better,and there is a significant correlation between the two indicators and LCR.

关 键 词：中心静脉血氧饱和度 下腔静脉呼吸变异指数 乳酸清除率 脓毒症 机械通气 

分 类 号：R515.3[医药卫生—内科学] R541.6[医药卫生—临床医学]