CAJ | 학술논문

目的研究每搏量变异度(stroke volume variation,SW)预测严重感染和感染性休克机械通气患者容量反应性的价值.方法前瞻观察性研究,对2009年1月至2010年3月北京大学深圳医院ICU严重感染和感染性休克机械通气患者28例进行容量负荷试验.超声心输出量监测仪无创监测心脏指数(cardiac index,CI)、每搏输出量指数(stroke volume index,SVI)、外周血管阻力(systemic vascular resistance,SVR)、SVV等血流动力学指标.根据容量负荷试验前后CI增加值是否大于12%分为有反应组和无反应组,组间比较应用两独立样本t检验;容量负荷试验前后比较应用配对t检验;受试者工作特征曲线评价SVV、中心静脉压(central venous pressure,CVP)以及容量负荷试验前后CVP变化值(△CVP)预测容量反应性的价值.结果容量负荷试验前,有反应组SW高于无反应组[(18.2±4.7)%和(12.7±4.2)%,P=0.003];而CVP两组差异无统计学意义[(10.2±4.0)cmH2O和(10.8±4.8)cmH2O,P＞0.05].容量负荷试验后,有反应组△CVP低于无反应组[(2.9±3.1)cmH2O和(5.3±2.7)cmH2O,P=0.037].SVV、CVP和△CVP的曲线下面积(AUC)分别是0.836(95%CI:0.680～0.992,P=0.003)、0.549(95%CI:0.329～0.768,P=0.662)和0.762(95%CI:0.570～0.953,P=0.019).SVV为15.5%时预测容量反应性的敏感度和特异度分别是84.6%和80%.结论 SVV预测严重感染和感染性休克机械通气患者的容量反应性具有良好价值,明显优于CVP、△CVP等传统指标.
목적 연구매박량변이도(stroke volume variation,SW)예측엄중감염화감염성휴극궤계통기환자용량반응성적개치.방법 전첨관찰성연구,대2009년1월지2010년3월북경대학심수의원ICU엄중감염화감염성휴극궤계통기환자28례진행용량부하시험.초성심수출량감측의무창감측심장지수(cardiac index,CI)、매박수출량지수(stroke volume index,SVI)、외주혈관조력(systemic vascular resistance,SVR)、SVV등혈류동역학지표.근거용량부하시험전후CI증가치시부대우12%분위유반응조화무반응조,조간비교응용량독립양본t검험;용량부하시험전후비교응용배대t검험;수시자공작특정곡선평개SVV、중심정맥압(central venous pressure,CVP)이급용량부하시험전후CVP변화치(△CVP)예측용량반응성적개치.결과 용량부하시험전,유반응조SW고우무반응조[(18.2±4.7)%화(12.7±4.2)%,P=0.003];이CVP량조차이무통계학의의[(10.2±4.0)cmH2O화(10.8±4.8)cmH2O,P＞0.05].용량부하시험후,유반응조△CVP저우무반응조[(2.9±3.1)cmH2O화(5.3±2.7)cmH2O,P=0.037].SVV、CVP화△CVP적곡선하면적(AUC)분별시0.836(95%CI:0.680～0.992,P=0.003)、0.549(95%CI:0.329～0.768,P=0.662)화0.762(95%CI:0.570～0.953,P=0.019).SVV위15.5%시예측용량반응성적민감도화특이도분별시84.6%화80%.결론 SVV예측엄중감염화감염성휴극궤계통기환자적용량반응성구유량호개치,명현우우CVP、△CVP등전통지표.
Objective To assess the role of stroke volume variation (SVV) in predicting the volume responsiveness of mechanically ventilated patients with severe sepsis and septic shock. Method A total of 28 mechanically ventilated patients with severe sepsis and septic shock were admitted from January 2009 to March 2010. Every patient was treated with volume loading test. Cardiac index (CI), stroke volume index (SVI), systemic vascular resistance (SVR) and SVV were measured non-invasively by Ultrasonic Cardiac Output Monitor (USCOM) device.Patients with an increase in CI ＞ 12% and ＜ 12% after volume loading test were classified as responders and nonresponders, respectively. The comparisons between these two sorts of patients were assessed by using two sample Student' s t -test, and comparisons between changes before and after volume loading test were assessed by using a paired Student's t -test. The roles of SVV, central venous pressure (CVP) and the changes of CVP (△CVP) after fluid administration in predicting volume responsiveness were evaluated by receiver operating characteristic (ROC) curves. Results Before volume loading test, the SVV was higher in responders in comparison with non-responders [(18.2 ± 4.7)% vs. (12.7 ± 4.2)%, P = 0.003] and the CVP was not significantly different between two groups [(10.2±4.0) cmH2O vs. (10.8±4.8) cmH2O, P ＞0.05]. After volume loading test,the CVP was lower in responders [(2.9 ± 3.1 ) cmH2O vs. (5.3 ± 2.7) cmH2O, P = 0.003]. The areas under the ROC curves (AUC) were 0.836 (95% CI:0.680 ～ 0.992,P = 0.003),0.549 (95% CI:0.329 ～ 0.768,P = 0.662)and 0.762 (95% CI:0.570 ～ 0.953,P = 0.019)for SVV, CVP and △CVP, respectively. The 15.5% of SVV value had the 84.6% of sensitivity and 80% of specificity for prediction of volume responsiveness. Conclusions SVV can serve as a valid indicator of predicting volume responsiveness in mechanically ventilated patients with severe sepsis and septic shock and it is more reliable than conventional indicators such as CVP and/△CVP.