床旁重症超声和脉搏指示剂连续心排出量监测指标对脓毒症休克患儿容量反应性的评估价值  

Application value of critical care ultrasound and pulse indicator continuous cardiac output monitoring index to volumetric reactivity in children with septic shock

作　　者：刘帅 王泽熙 程彩云 康磊[1] 郭月华 Liu Shuai;Wang Zexi;Cheng Caiyun;Kang Lei;Guo Yuehua(Department One of Intensive Care Unit,Hebei Children’s Hospital,Shijiazhuang Hebei 050031,China;Department of Neurological Rehabilitation,Hebei Children’s Hospital,Shijiazhuang Hebei 050031,China)

机构地区：[1]河北省儿童医院重症医学一科,河北石家庄050031 [2]河北省儿童医院神经康复科,河北石家庄050031

出　　处：《中国医刊》2025年第4期401-405,共5页Chinese Journal of Medicine

基　　金：河北省医学科学研究课题计划资助(20220742)。

摘　　要：目的探讨床旁重症超声和脉搏指示剂连续心排出量监测(PiCCO)在脓毒症休克患儿容量反应性评估中的应用价值。方法选取2021年10月至2023年1月就诊于河北省儿童医院重症医学一科的48例脓毒症休克患儿作为研究对象。所有患儿在30 min内输注醋酸钠林格注射液补液扩容。补液后,通过心脏超声监测CO变化,CO升高≥12%者作为容量反应阳性组(n=24),否则作为容量反应阴性组(n=24)。在补液前对所有患儿进行PiCCO监测,记录CO、血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)、胸腔内血容积指数(ITBVI)、全心舒张末血容量指数(GEDVI);同时进行床旁重症超声检查,记录下腔静脉内径、肺部超声评分(LUS)及双侧前胸壁均呈B线的患儿例数。采用受试者操作特征(ROC)曲线评估PiCCO监测指标及LUS对脓毒症休克患儿容量反应性的预测价值。结果容量反应阳性组患儿的EVLWI、PVPI、下腔静脉内径、LUS明显低于容量反应阴性组,差异有统计学意义(P<0.05),而两组患儿的CO、ITBVI、GEDVI和双侧前胸壁B线比例比较差异无统计学意义(P>0.05)。EVLWI预测脓毒症休克患儿容量反应性的ROC曲线下面积为0.747,最佳截断值为9.95 ml/kg,敏感度为63%,特异度为88%;PVPI预测脓毒症休克患儿容量反应性的ROC曲线下面积为0.852,最佳截断值为2.25,敏感度为67%,特异度为92%;LUS预测脓毒症休克患儿容量反应性的ROC曲线下面积为0.730,最佳截断值为8.5分,敏感度为58%,特异度为79%。结论床旁重症超声与PiCCO监测指标均可预测脓毒症休克患儿的容量反应性,指导精准液体管理,优化容量状态。Objective To investigate the clinical value of critical ultrasound and pulse indicator continuous cardiac output(PiCCO)in volume reactivity of children with septic shock.Method A total of 48 children with septic shock who were admitted to the intensive care unit in Hebei Children’s Hospital from October 2021 to January 2023 were selected.The patients were given 20 ml/kg sodium acetate ringer’s injection within half an hour.Afterfluid rehydration,the changes of CO were monitored by cardiac ultrasoud.Cardiac ultrasound indicated that CO increased by more than 12%,which was the volume positive group,and the other was the volume negative group.The PiCCO technology was used to monitor cardiac output,stroke volume,extravascular lung water index(EVLWI),pulmonary vascular penetration index(PVPI),intra-thoracic blood volume index and global end-diastolic volume index beforefluid rehydration.The chest wall was scanned by ultrasound.The inferior vena cava diameter,the lung ultrasound score(LUS)and the cases of B-line on both anterior chest walls was assessed.The receiver operating characteristic(ROC)curve was drawn to evaluate the significance of each index in assessing volumetric reactivity in children with septic shock.Result The EVLWI,PVPI,IVCD and LUS in the volume positive group were significantly lower than those in the volume negative group,and the difference was statistically significant(P<0.05).The area under the ROC curve of EVLWI for predicting volume responsiveness in children was 0.747,with the optimal cut-off value of 9.95 ml/kg,a sensitivity of 63%,and a specificity of 88%;the area under the ROC curve of PVPI for predicting volume responsiveness in children was 0.852,with the optimal cut-off value of 2.25,a sensitivity of 67%,and a specificity of 92%;the area under the ROC curve of LUS for predicting volume responsiveness in children was 0.730,with the optimal cut-off value of 8.5 points,a sensitivity of 58%,and a specificity of 79%.Conclusion Both bedside ultrasound and PiCCO monitoring can predict volum

关 键 词：床旁重症超声 脉搏指示剂连续心排出量监测 脓毒症休克 容量反应性 

分 类 号：R631.4[医药卫生—外科学]