血流动力学参数与脓毒症休克患者容量反应性的预测及相关性分析  

Prediction and Correlation Analysis of Hemodynamic Parameters and Volume Responsiveness in Patients with Septic Shock

作　　者：董倩倩 杨燕 刘德智 DONG Qianqian;YANG Yan;LIU Dezhi(Department of Critical Care Medicine,Xinxiang Central Hospital/Fourth Clinical College of Xinxiang Medical College,Xinxiang 453099,Henan,China)

机构地区：[1]新乡市中心医院/新乡医学院第四临床学院重症医学科,河南新乡453099

出　　处：《医用生物力学》2023年第6期1219-1225,共7页Journal of Medical Biomechanics

基　　金：中华国际医学交流基金项目(Z2018-35-2102)。

摘　　要：目的 探讨容量负荷试验前后脓毒症休克患者血流动力学参数的变化及对患者发生容量反应的预测价值。方法 选取脓毒症休克患者98例进行临床研究,根据补液治疗前后患者的每搏输出量变化值(ΔSV)分为容量负荷阳性组(ΔSV≥15%)53例、容量负荷阴性组(ΔSV<15%)45例,对比两组患者容量负荷试验前后脉搏指数连续心输出量(pulse-indicated continuous cardiac output,PICCO)、超声心动图相关指标,并采用受试者工作曲线(receiver operating curve,ROC)分析具有统计学意义的指标对于脓毒症休克患者发生容量负荷试验反应性的价值,采用Logistics回归模型分析各项参数与容量负荷试验反应的关系。结果 在容量负荷试验前,两组患者心排量(cardiac output,CO)、心脏指数(cardiac index,CI)、每搏输出量变异量(stroke volume variation,SVV)、中心静脉压(central venous pressure,CVP)、心率(heart rate,HR)测定值比较,差异均无统计学意义(P>0.05);试验后,容量负荷阳性组CO、CI、CVP测定值均高于容量负荷阴性组(P<0.05),HR、SVV均低于容量负荷阴性组(P<0.05)。容量负荷试验前,两组患者左室流出道(left ventricular outflow tract,LVOT)内径时间积分(VTI)峰值流速呼吸变异度、VEpeak测定值比较,差异均无统计学意义(P>0.05);试验后,容量负荷阳性组LVOT VTI测定值高于容量负荷阴性组(P<0.05),LVOT峰值流速呼吸变异度低于容量负荷阴性组(P<0.05);ROC曲线结果显示,HR、CO、CI、CVP、SVV、LVOT峰值流速呼吸变异度、LVOT VTI各项指标预测容量负荷反应阳性的曲线下面积(area under the curve,AUC)分别为0.515、0.560、0.556、0.499、0.898、0.912、0.922;Logistic回归模型结果显示,APACHEⅡ评分越高、SOFA评分越高、CO越低、CI越低、CVP越低、SVV越高、LVOT VTI越低、LVOT峰值流速呼吸变异度越大,是脓毒症休克患者容量负荷试验阴性的独立危险因素(P<0.05)。结论 密切监测脓毒症休克�Objective To explore the changes of hemodynamic parameters in septic shock patients before and after volume stress test,and their predictive value to the volume response of patients.Methods A total of 98 septic shock patients were selected for clinical research.According to the stroke volume change(ΔSV) of patients before and after rehydration treatment,the patients were divided into 53 cases of volume load positive group(ΔSV≥15%) and 45 cases of volume load negative group(ΔSV<15%).The pulse-indicated continuous cardiac output(PICCO) and echocardiogram related indexes for two groups of patients before and after the volume load test were compared,and the receiver operating curve(ROC) was used to analyze the value of statistically significant indexes for septic shock to the patient's response to the volume load test.A logistics regression model was used to analyze the relationship between various parameters and the volume load test response.Results Before the volume load test,the measured cardiac output(CO),cardiac index(CI),stroke volume variation(SVV),central venous pressure(CVP),heart rate(HR) values of patients in two groups were compared,and the difference was not statistically significant(P>0.05).After the test,the CO,CI,and CVP values of volume load positive group were all higher than those of volume load negative group(P<0.05),and the HR and SVV values were lower than those of volume load negative group(P<0.05).Before the volume load test,there was no significant difference in measured left ventricular outflow tract inner diameter velocity-time integral(LVOT VTI),LVOT peak flow velocity respiratory variability,and VEpeak values of patients between two groups(P>0.05).After the test,the LVOT VTI measurement value of the positive volume load group was higher than that of the negative volume load group(P<0.05),LVOT peak flow velocity respiratory variability was lower than volume load negative group(P<0.05).ROC curve results showed that for HR,CO,CI,CVP,SVV,LVOT peak flow velocity respiratory variability,LV

关 键 词：脓毒症 休克 血流动力学 容量反应 预测 

分 类 号：R318.01[医药卫生—生物医学工程]