葡萄糖初始分布容积联合被动抬腿试验对老年脓毒性休克患者容量反应性的预测价值  

Predictive Value of Initial Distribution Volume of Glucose Combined with Passive Leg Raising Test on Volume Responsiveness Assessment in Elderly Septic Shock Patients

作　　者：彭艳 肖飞 PENG Yan;XIAO Fei(Department Five of Cadre Ward,General Hospital of PLA Southern Theater Command,Guangzhou 510010,China;Department of Medical Intensive Care Unit,General Hospital of PLA Southern Theater Command,Guangzhou 510010,China;Department of Rheumatic(Traditional Chinese Medicine)Medical Center,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南部战区总医院干部病房五科,广州510010 [2]南部战区总医院MICU,广州510010 [3]南方医科大学南方医院风湿病(中医)诊疗中心,广州510515

出　　处：《医学综述》2023年第9期1826-1830,1837,共6页Medical Recapitulate

基　　金：广东省医学科学技术研究基金项目(B2018084)。

摘　　要：目的探讨葡萄糖初始分布容积(IDVG)联合被动抬腿试验(PLR)对老年脓毒性休克患者容量反应性的预测价值。方法选择2018年1—12月南部战区总医院MICU收治的68例老年脓毒性休克患者为研究对象,根据脉搏轮廓温度稀释连续心排血量监测技术所得每搏变异度(SVV)将患者分为容量负荷有反应组(SVV≥10%)和无反应组(SVV<10%)。比较两组患者基线及PLR时的心率、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)和IDVG变化,评价MAP、CVP、CI、IDVG、IDVG+PLR对老年脓毒性休克患者容量反应性的预测价值。结果68例老年脓毒性休克患者中,容量反应阳性(SVV≥10%)44例(有反应组),容量反应阴性(SVV<10%)24例。有反应组与无反应组基线和PLR时的心率、MAP、CVP比较差异无统计学意义(P>0.05),无反应组基线时的CI、IDVG均高于有反应组[(2.91±0.43)L/(min·m^(2))比(1.84±0.56)L/(min·m^(2))、(132±24)mg/kg比(109±28)mg/kg](P<0.05或P<0.01),且PLR时的CI、IDVG均高于有反应组[(2.88±0.51)L/(min·m^(2))比(1.88±0.54)L/(min·m^(2))、(152±28)mg/kg比(111±23)mg/kg](P<0.01)。Pearson相关性分析结果显示,IDVG与CI呈正相关(r=0.637,P<0.001),与SVV呈负相关(r=-0.529,P=0.001),而与心率、CVP、MAP无相关性(P>0.05)。CI、IDVG、IDVG+PLR、CVP、MAP预测老年脓毒性休克患者容量反应性的受试者工作特征曲线下面积分别为0.917、0.753、0.891、0.663、0.540。IDVG+PLR预测容量反应性的灵敏度为0.846,特异度为0.833,阳性预测值为0.840,阴性预测值为0.840。结论老年脓毒性休克患者在容量负荷无反应时的IDVG显著升高,IDVG+PLR可用于评估老年脓毒性休克患者的容量反应性。Objective To investigate the predictive value of Initial distribution volume of glucose(IDVG)combined with passive leg raising(PLR)test on volume responsiveness assessment in elderly septic shock patients.Methods A total of 68 elderly septic patients admitted to medical intensive care unit(MICU)of General Hospital of PLA Southern Theater Command from Jan.2018 to Dec.2018 were enrolled.According to stroke volume variation(SVV)from pulse-indicator continuous cardiac output,the patients were divided into a volume load response group(SVV≥10%)and a non-response group(SVV<10%).The changes of heart rate,mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI)and IDVG at baseline and PLR were compared between the two groups to evaluate the predictive value of MAP,CVP,CI,IDVG and IDVG+PLR for volume responsiveness in elderly patients with septic shock.Results Among the 68 elderly patients with septic shock,44 were in the response group(SVV≥10%)and 24 were in the non-response group(SVV<10%).There was no significant difference in heart rate,MAP and CVP at baseline and PLR between the response group and the non-response group(P>0.05).CI and IDVG at baseline in the non-response group were higher than those in the response group[(2.91±0.43)L/(min·m^(2))vs(1.84±0.56)L/(min·m^(2)),(132±24)mg/kg vs(109±28)mg/kg](P<0.05 or P<0.01),the CI and IDVG at PLR were higher than those of the response group[(2.88±0.51)L/(min·m^(2))vs(1.88±0.54)L/(min·m^(2)),(152±28)mg/kg vs(111±23)mg/kg](P<0.01).Pearson correlation analysis showed that IDVG was positively correlated with CI(r=0.637,P<0.001)and negatively correlated with SVV(r=-0.529,P=0.001),but had no correlation with heart rate,CVP and MAP(P>0.05).The area under the receiver operating curve of CI,IDVG,IDVG+PLR,CVP and MAP predicting volume responsiveness of elderly septic shock patients were 0.917,0.753,0.891,0.663 and 0.540 respectively.The sensitivity,specificity,positive predictive value and negative predictive value of IDVG+PLR in predicting fluid res

关 键 词：老年脓毒性休克 葡萄糖初始分布容积 被动抬腿试验 容量反应性 

分 类 号：R631[医药卫生—外科学]