脓毒症休克患者腹内压和下腔静脉呼吸变异度对预测患者容量反应性的价值研究  

Effects of the variation of abdominal pressure and inferior vena cava respiration on volume reactivity in septic shock patients

作　　者：吴永伟[1] 卢子瑄 秦险峰 WU Yong-wei;LU Zi-xuan;QIN Xian-feng(Department of Emergency,Seventh People s Hospital of Shanghai University of Traditional Chinese Medicine,Shanghai 200137;Department of Emergency,Pudong New Area Medical Emergency Center,Shanghai 201206,China)

机构地区：[1]上海中医药大学附属第七人民医院急诊科,上海200137 [2]浦东新区医疗急救中心急救科,上海201206

出　　处：《川北医学院学报》2024年第2期239-242,共4页Journal of North Sichuan Medical College

基　　金：上海中医药大学预算内科研项目(2021LK059);上海市卫生和计划生育委员会中医药科技创新项目(ZYKC201701085)。

摘　　要：目的:探究脓毒症休克患者腹内压、下腔静脉呼吸变异度(IVC-RVI)对预测患者容量反应性的价值研究。方法:选择86例脓毒症休克患者为研究对象,根据液体复苏后容量反应性情况分为无反应组(n=59)和反应组(n=27)。监测患者液体复苏前及复苏后6 h腹内压、IVC-RVI,分析其对容量反应性的影响。结果:两组患者的年龄、性别、合并基础疾病、感染部位、急性生理学与慢性健康状况评分Ⅱ(APACHEII)、收缩压(SBP)及心率(HR)均无统计学差异(P>0.05);两组患者复苏前腹内压比较,差异无统计学意义(P>0.05);液体复苏后6 h,两组患者腹内压均升高,且无反应组腹内压及复苏前后腹内压差值均高于反应组(P<0.05)。无反应组IVC-RVI低于反应组(P<0.05)。Logistic回归分析显示,IVC-RVI、复苏后6 h腹内压为脓毒症休克患者容量反应性的独立影响因素(P<0.05)。受试者工作特征曲线分析显示,复苏后6 h腹内压、IVC-RVI预测脓毒症休克患者无容量反应性的截断值分别为9.860 mmHg、16.95%,敏感度分别为78.00%、50.00%,特异度分别为82.00%、50.00%,曲线下面积(AUC)分别为0.782、0.722(P<0.05)。两个指标联合预测的价值最高(P<0.05),AUC为0.817(95%CI:0.725~0.909),敏感度、特异度分别为84.00%、78.00%。结论:腹内压偏高、IVC-RVI偏低是导致脓毒症休克患者液体复苏后无容量反应性的影响因素,临床治疗中可据此合理制定液体复苏方案,以提高治疗效果,降低并发症风险。Objective:To investigate the effects of internal abdominal pressure and inferior vena cava respiratory variability(IVC-RVI)on volume reactivity in patients with septic shock.Methods:86 septic shock patients were divided into an unresponsive group(n=59)and a reactive group(n=27)based on their volume responsiveness after fluid resuscitation.Intra-abdominal pressure and IVC-RVI were monitored before and 6 hours after fluid resuscitation and their effects on volumetric reactivity were analyzed.Results:There were no differences in age,sex,combined underlying diseases,infection site,acute physiology and chronic health status score II(APACHEII),systolic blood pressure(SBP)and heart rate(HR)between the two groups(P>0.05).There was no significant difference in intra-abdominal pressure before resuscitation between the two groups(P>0.05).The intra-abdominal pressure at 6 h after fluid resuscitation experienced an increase in both groups,and the difference before and after resuscitation in the non-response group were higher than those in the reaction group(P<0.05).The IVC-RVI in the unresponsive group was lower than that in the reactive group(P<0.05).Logistic regression analysis showed that IVC-RVI and intra-abdominal pressure 6 h after resuscitation were independent factors for volume reactivity in septic shock patients(P<0.05).ROC analysis showed that the cut-off values of intraabdominal pressure and IVC-RVI for predicting volumicreactivity in septic shock patients 6 h after resuscitation were 9.860 mmHg and 16.95%,sensitivity was 78.00%and 50.00%,specificity was 82.00%and 50.00%,respectively.The AUC was 0.782 and 0.722(P<0.05),respectively.The combined prediction value of the two indexes was the highest(P<0.05),and the AUC was 0.817(95%CI:0.725~0.909).Sensitivity and specificity were 84.00%and 78.00%,respectively.Conclusion:High intra-abdominal pressure and low IVC-RVI are the factors that lead to involemic reactivity after fluid resuscitation in septic shock patients.Therefore,fluid resuscitation protocols can be reasona

关 键 词：脓毒症休克 腹内压 下腔静脉变异度 容量反应性 

分 类 号：R631.4[医药卫生—外科学]