外周灌注指数在脓毒症患者液体复苏过程中预测液体反应性的临床价值  

The value of peripheral perfusion index in the fluid therapy process of the patients with sepsis

作　　者：侯静 王冲 戴亮 陈小东 马子东 冯朋 HOU Jing;WANG Chong;DAI Liang;CHEN Xiaodong;MA Zidong;FENG Peng(Department of Emergency,Lixin County People′s Hospital,Bozhou 236700,China)

机构地区：[1]亳州市利辛县人民医院急诊科,亳州236700

出　　处：《中国临床保健杂志》2024年第6期760-764,共5页Chinese Journal of Clinical Healthcare

摘　　要：目的 探讨外周灌注指数(PPI)预测脓毒症患者容量反应性的临床价值。方法 选择2021年4月至2024年7月利辛县人民医院收治的65例脓毒症患者为研究对象,明确脓毒症诊断后立即进行液体冲击试验以判断患者的液体反应性。液体冲击试验方法是在1 min内推注200 mL晶体液,液体推注后如果超声心动图示速度时间积分(VTI)增加10%,则被视为容量有反应性,随后在15 min内继续输注晶体溶液300 mL以验证容量反应性。结果 36例患者对液体冲击试验有反应。快速推注200 mL晶体液后,外周灌注指数变化值(ΔPPI)预测液体反应性的截断值为10.99%[受试者工作特征曲线下面积(AUC)=0.99,灵敏度为100%,特异度为94.4%];继续输注300 mL晶体液后,ΔPPI预测液体反应性的截断值为16.67%(AUC=0.97,灵敏度为82.7%,特异度为100%);两者AUC比较,差异无统计学意义(P=0.118)。结论 脓毒症患者液体治疗过程中,ΔPPI在预测液体反应性方面有较好的临床价值。Objective To evaluate the clinical value of peripheral perfusion index(PPI)in predicting fluid responsiveness in patients with sepsis.Methods A total of 65 patients with sepsis admitted to Lixin County People′s Hospital between April 2021 and July 2024 were selected for the study.Following a confirmed diagnosis of sepsis,a fluid challenge test was immediately conducted to assess the patients′fluid responsiveness.The fluid challenge method involved rapid infusion of 200 mL crystalloid solution within one minute.If the velocity time integral(VTI)increased by 10%after fluid infusion,the patient was considered fluid-responsive.Subsequently,an additional 300 mL of crystalloid solution was infused over 15 minutes to further verify fluid responsiveness.Results Thirty-six patients responded to the fluid challenge test.After the rapid infusion of 200 mL crystalloid,the criticalΔPPI value for predicting fluid responsiveness was 10.99%(AUC=0.99,sensitivity=100%,specificity=94.4%).After the additional infusion of 300 mL fluid,the criticalΔPPI value for predicting fluid responsiveness was 16.67%(AUC=0.97,sensitivity=82.7%,specificity=100%).There was no statistically significant difference in the area under the curve(P=0.118)between two groups.Conclusion During fluid therapy in septic patients,PPI demonstrates good clinical value in predicting fluid responsiveness.

关 键 词：脓毒症 休克 灌注指数 心排血量 

分 类 号：R73[医药卫生—肿瘤]