呼气末阻断试验联合左室流出道速度时间积分判断脓毒性休克并机械通气患者容量反应性意义  

EEO with VTI variability of the left ventricular outflow tract to predict volume responsiveness in patients with septic shock undergoing mechanical ventilation

作　　者：王婉 谢永鹏[1] 康秀文[1] 顾彩虹[1] 郑慧[1] 刘素霞[1] WANG Wan;XIE Yongpeng;KANG Xiuwen;GU Caihong;ZHENG Hui;LIU Suxia(Department of Intensive Care Unit,the First People's Hospital of Lianyungang,Lianyungang,Jiangsu,222002,China)

机构地区：[1]连云港市第一人民医院重症医学科,江苏连云港222002

出　　处：《临床急诊杂志》2023年第10期529-534,共6页Journal of Clinical Emergency

摘　　要：目的:评估呼气末阻断试验(end-expiratory occlusions, EEO)对左室流出道速度-时间积分(velocity-time integral, VTI)的影响是否可以预测脓毒性休克并机械通气患者容量反应性。方法:采用前瞻性研究方法,选择2020年1月-2022年11月入住连云港市第一人民医院重症监护病房(intensive care unit, ICU)的脓毒性休克并机械通气患者60例,入组后行右侧颈内静脉或者锁骨下静脉穿刺,置入中心静脉导管,持续测量中心静脉压力(central venous pressure, CVP),记录基线CVP,通过超声测量基线VTI,首先给予15 s呼气末阻塞,在呼气末阻塞的最后5 s期间记录VTI,取5次均值,并记录CVP、心率(heart rate, HR)、平均动脉压力(mean arterial pressure, MAP)。EEO 5 min后进行容量负荷试验(VE),生理盐水500 mL于10 min中内静脉滴注,然后测量VTI,取5次均值,并记录CVP、HR、MAP。计算EEO前与EEO期间VTI变异率(ΔVTIEEO)、CVP变异率(ΔCVPEEO)、HR变异率(ΔHREEO)、MAP变异率(ΔMAPEEO),VE前后VTI变异率(ΔVTIVE)、CVP变异率(ΔCVPVE)、HR变异率(ΔHRVE)、MAP变异率(ΔMAPVE),根据ΔVTIVE上升10%分为有反应组和无反应组。比较两组之间统计学差异,对ΔVTIEEO与ΔVTIVE、ΔCVPEEO与ΔVTIVE、ΔCVPVE与ΔVTIVE、EEO期间CVP与ΔVTIVE、VE后CVP与ΔVTIVE进行相关性分析,绘制ΔVTIEEO、ΔCVPEEO、ΔCVPVE、EEO期间CVP、VE后CVP的受试者工作特征(receiver operator characteristic, ROC)曲线。分析EEO期间VTI变异率对脓毒性休克患者容量反应性意义。结果:两组患者ΔHREEO、ΔMAPEEO比较差异无统计学意义(P>0.05),两组EEO期间HR、MAP、VTI比较差异无统计学意义(P>0.05)、两组患者ΔCVPEEO、ΔVTIEEO、EEO期间CVP比较差异有统计学意义(P<0.05)。两组ΔHRVE、ΔMAPVE比较差异无统计学意义(P>0.05),两组VE后HR、MAP、VTI比较差异无统计学意义(P>0.05)、两组患者ΔVTIVE、ΔCVPVE、VE后CVP比较差异有统计学意义(P<0.05)。ΔVTIEEO与ΔVTIVE变化呈显著正相�Objective:To evaluate whether the effect of end-expiratory occlusions(EEO)on velocity-time integral of the left ventricular outflow tract can predict volume responsiveness in patients with septic shock undergoing Mechanical Ventilation.Methods:This prospective study enrolled 60 patients with septic shock undergoing mechanical ventilation in Intensive Care Unite in the First People's Hospital of Lianyungang City from January 2020 to November 2022.After admission,they underwent right internal jugular vein or subclavian vein puncture to place a central venous catheterto continuously measure central venous pressure(CVP)and record baseline CVP.VTI was measured by ultrasound.Firstly,give a 15 s EEO,VTI was measured during the last 5S of 15-EEO,and take the average of 5 times,and CVP,HR,MAP were recorded.After 5 minutes,500 mL of physiological saline was administered intravenously in 10 minutes for volume load test(VE),and VTI was measured again after VE,and the mean value was taken 5 times,and CVP,HR,and MAP were recorded.The velocity-time integral respiratory variability of the left-ventricular outflow tract(△VTIo),CVP variability(△CVPeEo)、HR variability(AHREEo),MAP variability(△MAPeeo)before and after EEO and the velocity-time integral respiratory variability of the leftventricular outflow tract(△VTIve)、CVP variability(CVPve)、HR variability(△HRve)、and MAP variability(AMAPve)before and after VE were calculated.A 10%increase in AVTIve was divided into a response group and a non-response group.The statistical differences between the two groups were compared,and correlation analysis was performed on AVTIEEO and△VTIVE,ACVPEEO and AVTIVE,ACVPve and AVTIve,CVP during EEO and △VTIve CVP after VE and △VTIve.A receiver operating characteristic(ROC)curve of △VTIve,ACVPeEo,ACVPve,CVP during EEO and CVP after VE was plotted.Results:There was no significant difference in AHR and MAP between the two groups before and after EEO(P>0.05).There was no significant difference in HR,MAP,and VTI during EEO between

关 键 词：呼气末阻断试验 左室流出道速度时间积分 容量反应性 脓毒性休克 

分 类 号：R459.7[医药卫生—急诊医学]