超声监测不同动脉峰值流速对评估脓毒性休克病人容量反应性的预测价值  

Predictive value of ultrasound monitoring different arterial peak velocity in evaluating fluid responsiveness in patients with septic shock

作　　者：娄侠儒 林艺韵 罗锦麟 吴翔 陶飞 LOU Xiaru;LIN Yiyun;LUO Jinlin;WU Xiang;TAO Fei(Department of Intensive Care Unit,Foshan,Guangdong 528031,China;Department of Ultrasound,Foshan Fosun Chancheng Hospital,Foshan,Guangdong 528031,China)

机构地区：[1]佛山复星禅诚医院重症医学科,广东佛山528031 [2]佛山复星禅诚医院超声科,广东佛山528031

出　　处：《安徽医药》2025年第5期996-1000,共5页Anhui Medical and Pharmaceutical Journal

基　　金：佛山市科技创新项目(2020001004686);佛山市“十四五”医学培育专科项目(佛卫函〔2021〕107号)。

摘　　要：目的通过超声比较动脉血流峰流速变异度评估脓毒性休克病人容量反应性的准确性。方法选取2021年3月至2022年9月佛山复星禅诚医院重症医学科72例脓毒性休克病人,均需要机械通气,早期均予以集束化治疗,然后再评估其容量反应性,如容量负荷试验(VE)后,心脏每搏量(SV)增加≥15%为有反应组(容量反应阳性),SV增加<15%则为无反应组(容量反应阴性)。比较不同动脉血流峰流速变异度在两组VE前后的变化,比较其与ΔSV的相关性,评估其对容量反应特性的预测价值。结果研究阶段共入选脓毒性休克病人72例,其中有反应组39例,无反应组33例。VE前,有反应组的主动脉血流峰流速变异度(ΔVpeak-AO)、颈总动脉血流峰流速变异度(ΔVpeak-CA)、肱动脉血流峰流速变异度(ΔVpeak-BA)、股动脉血流峰流速变异度(ΔVpeak-FA)分别是(15.25±5.12)%、(13.40±2.06)%、(14.67±2.18)%、(11.44±2.14)%,无反应组分别是(12.50±2.37)%、(10.27±2.44)%、(11.98±2.48)%、(8.77±2.40)%,两组比较差异有统计学意义(P<0.05)。但VE后,两组各动脉血流峰流速变异度均差异无统计学意义(P>0.05);根据相关性分析,VE前的ΔVpeak-AO、ΔVpeak-CA、ΔVpeak-BA、ΔVpeak-FA与ΔSV均成直线关系(r值分别为0.89、0.86、0.82、0.78,均P<0.05);ROC曲线分析显示,VE前ΔVpeak-AO、ΔVpeak-CA、ΔVpeak-BA、ΔVpeak-FA曲线下面积(AUC)依次为0.88、0.89、0.86、0.84。当ΔVpeak-AO预测容量反应性的最佳临界值为13.23%时,灵敏度为82.05%,特异度为84.85%。当ΔVpeak-CA最佳临界值为11.78%时,灵敏度为87.18%,特异度为78.79%。当ΔVpeak-BA最佳临界值为12.01%时,灵敏度为76.92%,特异度为87.88%。当ΔVpeak-FA最佳临界值为8.86%时,灵敏度为82.05%,特异度为75.76%。结论超声监测ΔVpeak-AO、ΔVpeak-CA、ΔVpeak-BA、ΔVpeak-FA均能对机械通气脓毒性休克病人的容量反应性有效预测,以ΔVpeak-CA的特异度和灵敏度最佳。Objective To compare the accuracy of peak velocity variation of arterial blood flow by ultrasound in evaluating fluid responsiveness in patients with septic shock.Methods Seventy-two patients with septic shock in the Department of Intensive Care Unit in Foshan Fosun Chancheng Hospital from March 2021 to September 2022 were selected,all patients required mechanical ventilation,bundled therapy was given in the early stage,and then evaluated for volume expansion(VE),such as the stroke volume(SV)increased≥15%after VE,as a response group(fluid reaction positive),and SV increased<15%was defined as a non-response group(fluid reaction negative).The variation of different arterial peak velocity before and after VE was compared between the two groups,and its correlation withΔSV was compared,and its predictive value on volume responsiveness was compared.Results A total of 72 patients with septic shock were enrolled during the study,including 39 patients in the response group and 33 patients in the non-response group.Before VE,the peak velocity variation of aorta(ΔVpeak-AO),peak velocity variation of cephalic artery(ΔVpeak-CA),peak velocity variation of brachial artery(ΔVpeak-BA),peak velocity variation of femoral artery(ΔVpeak-FA)of the response group were(15.25±5.12)%,(13.40±2.06)%,(14.67±2.18)%,(11.44±2.14)%,and non-response group was(12.50±2.37)%,(10.27±2.44)%,(11.98±2.48)%,(8.77±2.40)%,two groups are significant difference(P<0.05).But after VE,there was no statistically significant difference in the variation of arterial peak velocity between the two groups(P>0.05).According to the correlation analysis,ΔVpeak-AO,ΔVpeak-CA,ΔVpeak-BA,ΔVpeak-FA showed linear correlation withΔSV before VE(r values were 0.89,0.86,0.82,0.78,both P<0.05).ROC curve analysis showed that the area under ROC curve(AUC)ofΔVpeak-AO,ΔVpeak-CA,ΔVpeak-BA,ΔVpeak-FA were 0.88,0.89,0.86,0.84 in evaluating fluid responsiveness before VE.WhenΔVpeak-AO predicted the optimal critical value of fluid responsiveness was 13.23%,the sensiti

关 键 词：休克 脓毒性 容量反应性 动脉血流峰流速变异度 重症超声 机械通气 集束化治疗 准确性 

分 类 号：R459.7[医药卫生—急诊医学]