中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
6期
612-616
,共5页
陆军%丁月平%王飞%赵滋苗%叶肖琳%马丹女%宋希玲
陸軍%丁月平%王飛%趙滋苗%葉肖琳%馬丹女%宋希玲
륙군%정월평%왕비%조자묘%협초림%마단녀%송희령
急性呼吸窘迫综合征%机械通气%每搏输出量%预后%病死率%血流动力学%液体反应性%重症监护
急性呼吸窘迫綜閤徵%機械通氣%每搏輸齣量%預後%病死率%血流動力學%液體反應性%重癥鑑護
급성호흡군박종합정%궤계통기%매박수출량%예후%병사솔%혈류동역학%액체반응성%중증감호
Acute respiratory stress syndrome%Mechanical ventilation%Stroke volume%Prognosis%Mortality%Hemodynamics%Fluid responsiveness%Critical care
目的 探讨液体反应性对急性呼吸窘迫综合征(ARDS)患者的预后价值.方法 本前瞻性临床研究在浙江中医药大学附属第二医院ICU进行.59例在接受机械通气的ARDS患者,采用脉搏波指示连续心排血量( PiCCO)技术测定其每搏输出量变异(SVV),根据SVV值将患者分为液体有反应组(SVV≥15％)和液体无反应组(SVV＜15％)；比较两组患者28 d生存率、ICU住院时间、机械通气时间的差异；Kaplan-Meier法分析患者累积生存情况；采用Logistic回归分析SVV与患者28 d生存率的关系.结果 与液体无反应组比较,液体有反应组患者28d生存率明显增高(85.3％ vs.56.0％,P=0.012),ICU住院时间明显减少[((13.1±5.2) d vs.(21.6±9.0)d,P=0.008)、机械通气时间明显缩短[(11.4±5.3) d vs.(18.3±4.9)d,P=0.022]；Logistic回归分析显示:SVV＜ 15％显著增高ARDS患者28d死亡风险(OR=4.82; 95％ CI:2.67～11.71,P=0.009).结论 以SVV为基础的液体反应性可以作为ARDS患者的预后指标.
目的 探討液體反應性對急性呼吸窘迫綜閤徵(ARDS)患者的預後價值.方法 本前瞻性臨床研究在浙江中醫藥大學附屬第二醫院ICU進行.59例在接受機械通氣的ARDS患者,採用脈搏波指示連續心排血量( PiCCO)技術測定其每搏輸齣量變異(SVV),根據SVV值將患者分為液體有反應組(SVV≥15％)和液體無反應組(SVV＜15％)；比較兩組患者28 d生存率、ICU住院時間、機械通氣時間的差異；Kaplan-Meier法分析患者纍積生存情況；採用Logistic迴歸分析SVV與患者28 d生存率的關繫.結果 與液體無反應組比較,液體有反應組患者28d生存率明顯增高(85.3％ vs.56.0％,P=0.012),ICU住院時間明顯減少[((13.1±5.2) d vs.(21.6±9.0)d,P=0.008)、機械通氣時間明顯縮短[(11.4±5.3) d vs.(18.3±4.9)d,P=0.022]；Logistic迴歸分析顯示:SVV＜ 15％顯著增高ARDS患者28d死亡風險(OR=4.82; 95％ CI:2.67～11.71,P=0.009).結論 以SVV為基礎的液體反應性可以作為ARDS患者的預後指標.
목적 탐토액체반응성대급성호흡군박종합정(ARDS)환자적예후개치.방법 본전첨성림상연구재절강중의약대학부속제이의원ICU진행.59례재접수궤계통기적ARDS환자,채용맥박파지시련속심배혈량( PiCCO)기술측정기매박수출량변이(SVV),근거SVV치장환자분위액체유반응조(SVV≥15％)화액체무반응조(SVV＜15％)；비교량조환자28 d생존솔、ICU주원시간、궤계통기시간적차이；Kaplan-Meier법분석환자루적생존정황；채용Logistic회귀분석SVV여환자28 d생존솔적관계.결과 여액체무반응조비교,액체유반응조환자28d생존솔명현증고(85.3％ vs.56.0％,P=0.012),ICU주원시간명현감소[((13.1±5.2) d vs.(21.6±9.0)d,P=0.008)、궤계통기시간명현축단[(11.4±5.3) d vs.(18.3±4.9)d,P=0.022]；Logistic회귀분석현시:SVV＜ 15％현저증고ARDS환자28d사망풍험(OR=4.82; 95％ CI:2.67～11.71,P=0.009).결론 이SVV위기출적액체반응성가이작위ARDS환자적예후지표.
Objective To investigate the prognostic value of fluid responsiveness in patients with acute respiratory stress syndrome (ARDS).Methods Fifty-nine mechanically ventilated patients with ARDS were enrolled.Their stroke volume variations (SVV) were detected by pulse contour continuous cardiac output (PiCCO) analysis device,and then the patients were subsequently divided into fluid responsive group (SVV≥15％) and fluid non-responsive group (SVV ＜ 15％ ).The differences in 28-day survival,length of ICU stay and duration of mechanical ventilation between the 2 groups were compared.Thereafter,the 28-day survival of patients was analyzed by Kaplain-Meier survival model and the relationship between SVV and mortality within 28 days was analyzed by logistic regression model.Results In comparison with fluid non-responsive group,the 28-day survival of fluid responsive group was significantly increased (85.3％ vs.56.0％,P =0.012),the length of ICU stay was significantly shortened [( 13.1 ±5.2 ) d vs. (21.6±9.0) d,P=0.008],and the duration of mechanical ventilation was significantly shortened as well [( 11.4 ± 5.3 ) d vs.( 18.3 ± 4.9) d,P =0.022] ; Logistic analysis revealed that SVV ＜ 15％ increased the risk of 28-day mortality ( OR =4.82 ; 95％ CI:2.67 ～ 11.71,P =0.009 ).Conclusions SVV-based fluid responsiveness can be served as a prognostic predictor for ventilated patients with ARDS.
