中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
4期
361-365
,共5页
被动直腿抬高试验%液体复苏%血流动力学监测%每搏量指数%中心静脉压%严重脓毒症%液体反应%ROC曲线
被動直腿抬高試驗%液體複囌%血流動力學鑑測%每搏量指數%中心靜脈壓%嚴重膿毒癥%液體反應%ROC麯線
피동직퇴태고시험%액체복소%혈류동역학감측%매박량지수%중심정맥압%엄중농독증%액체반응%ROC곡선
Passive leg raising%Fluid resuscitation%Hemodynamic monitoring%Stroke volumeindex%Central venous pressure%Severe sepsis%Fluid responsiveness%ROC curve
目的 探讨被动直腿抬高试验(passive leg raising,PLR)在判断严重脓毒症的机械通气患者中血流动力学反应的作用,指导脓毒性患者的容量复苏.方法 前瞻性研究,入选2010年5月至2011年5月浙江大学医学院附属第一医院ICU和宁波市医疗中心李惠利医院ICU,符合严重脓毒症诊断标准的机械通气患者28例进行液体复苏.排除非窦性心律者、心律不齐者和产妇.用脉搏波指示剂连续心排血量( pulse indicator continuous cardiac output,PiCCO)技术分别记录在半卧位、PLR后、液体输注后(30 min内快速输注6％羟乙基淀粉500 ml)的血流动力学参数.根据每搏量指数变化(△SVI)是否大于等于15％,分为液体反应阳性组和液体反应阴性组.比较两组间基线水平时心率(HR)、收缩压(ABPs)、舒张压(ABPd)、平均动脉压(ABPm)、平均中心静脉压(CVPm)和心指数(CI)的差异；比较两组患者PLR后及快速输液后ABPs、ABPm、CVPm、SVI与基线水平之间的差异；ROC曲线评价△SVI、△CVPm对预测患者液体反应的价值.用SPSS17.0统计软件包进行统计分析.结果 28例患者中液体反应阳性组18例,液体反应阴性组10例.液体反应阳性组PLR后ABPs、ABPm、CVPm比基线水平显著升高[(115.9±13.1) vs.(100.1±18.1),(77.8±13.0) vs,(68.1±12.4),(10.1±4.1)vs.(7 2±3.4)],分别为P=0.005,P=0.03,P=0.03.PLR后,△SVI和△CVPm预测液体反应阳性的ROC曲线下面积分别为0.897±0.059(95％CI=0.762 ～ 1.000)和0.819±0.081(95％CI=0.661～0.977).分别取△SVI=10.5％和△CVPm=12.7％为界值,预测患者液体反应阳性的敏感性为72.2％和72.2％,特异性为90.0％和80.0％.结论 PLR后的△SVI和△CVPm可以作为严重脓毒症机械通气患者的一项准确而可逆的液体反应预测指标.
目的 探討被動直腿抬高試驗(passive leg raising,PLR)在判斷嚴重膿毒癥的機械通氣患者中血流動力學反應的作用,指導膿毒性患者的容量複囌.方法 前瞻性研究,入選2010年5月至2011年5月浙江大學醫學院附屬第一醫院ICU和寧波市醫療中心李惠利醫院ICU,符閤嚴重膿毒癥診斷標準的機械通氣患者28例進行液體複囌.排除非竇性心律者、心律不齊者和產婦.用脈搏波指示劑連續心排血量( pulse indicator continuous cardiac output,PiCCO)技術分彆記錄在半臥位、PLR後、液體輸註後(30 min內快速輸註6％羥乙基澱粉500 ml)的血流動力學參數.根據每搏量指數變化(△SVI)是否大于等于15％,分為液體反應暘性組和液體反應陰性組.比較兩組間基線水平時心率(HR)、收縮壓(ABPs)、舒張壓(ABPd)、平均動脈壓(ABPm)、平均中心靜脈壓(CVPm)和心指數(CI)的差異；比較兩組患者PLR後及快速輸液後ABPs、ABPm、CVPm、SVI與基線水平之間的差異；ROC麯線評價△SVI、△CVPm對預測患者液體反應的價值.用SPSS17.0統計軟件包進行統計分析.結果 28例患者中液體反應暘性組18例,液體反應陰性組10例.液體反應暘性組PLR後ABPs、ABPm、CVPm比基線水平顯著升高[(115.9±13.1) vs.(100.1±18.1),(77.8±13.0) vs,(68.1±12.4),(10.1±4.1)vs.(7 2±3.4)],分彆為P=0.005,P=0.03,P=0.03.PLR後,△SVI和△CVPm預測液體反應暘性的ROC麯線下麵積分彆為0.897±0.059(95％CI=0.762 ～ 1.000)和0.819±0.081(95％CI=0.661～0.977).分彆取△SVI=10.5％和△CVPm=12.7％為界值,預測患者液體反應暘性的敏感性為72.2％和72.2％,特異性為90.0％和80.0％.結論 PLR後的△SVI和△CVPm可以作為嚴重膿毒癥機械通氣患者的一項準確而可逆的液體反應預測指標.
목적 탐토피동직퇴태고시험(passive leg raising,PLR)재판단엄중농독증적궤계통기환자중혈류동역학반응적작용,지도농독성환자적용량복소.방법 전첨성연구,입선2010년5월지2011년5월절강대학의학원부속제일의원ICU화저파시의료중심리혜리의원ICU,부합엄중농독증진단표준적궤계통기환자28례진행액체복소.배제비두성심률자、심률불제자화산부.용맥박파지시제련속심배혈량( pulse indicator continuous cardiac output,PiCCO)기술분별기록재반와위、PLR후、액체수주후(30 min내쾌속수주6％간을기정분500 ml)적혈류동역학삼수.근거매박량지수변화(△SVI)시부대우등우15％,분위액체반응양성조화액체반응음성조.비교량조간기선수평시심솔(HR)、수축압(ABPs)、서장압(ABPd)、평균동맥압(ABPm)、평균중심정맥압(CVPm)화심지수(CI)적차이；비교량조환자PLR후급쾌속수액후ABPs、ABPm、CVPm、SVI여기선수평지간적차이；ROC곡선평개△SVI、△CVPm대예측환자액체반응적개치.용SPSS17.0통계연건포진행통계분석.결과 28례환자중액체반응양성조18례,액체반응음성조10례.액체반응양성조PLR후ABPs、ABPm、CVPm비기선수평현저승고[(115.9±13.1) vs.(100.1±18.1),(77.8±13.0) vs,(68.1±12.4),(10.1±4.1)vs.(7 2±3.4)],분별위P=0.005,P=0.03,P=0.03.PLR후,△SVI화△CVPm예측액체반응양성적ROC곡선하면적분별위0.897±0.059(95％CI=0.762 ～ 1.000)화0.819±0.081(95％CI=0.661～0.977).분별취△SVI=10.5％화△CVPm=12.7％위계치,예측환자액체반응양성적민감성위72.2％화72.2％,특이성위90.0％화80.0％.결론 PLR후적△SVI화△CVPm가이작위엄중농독증궤계통기환자적일항준학이가역적액체반응예측지표.
Objective To assess the value of legs passively lifted as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis.Methods Twenty-eight mechanically ventilated patients with severe sepsis admitted from May 2010 to May 2011 for volume resuscitation were collected.Patients with non-sinus rhythm or arrhythmia and parturients were excluded. Variation of hemodynamics of the patients in a semi-recumbent position,after passive leg raising (PLR) and after volume expansion (500 ml 6％ hydroxyethyl starch infusion within 30 mins) was studied by using the technique of pulse indicator continuous cardiac output (PiCCO) system.The volume resuscitation were resulted into two groups,responder and non-responder,as per △SVI (stroke volume index) over 15％.HR,arterial systoicblood pressure (ABPs),arterial diastolic blood pressure (ABPd),mean arterial blood pressure (ABPm),mean central venous pressure (CVPm) and cardiac index (CI) were compared between two groups.The changes of ABPs,ABPm,CVPm and SVI after PLR and after fluid resuscitation werc compared with those before PLR and fluid resuscitation.The ROC curve was drawn to evaluate the value of △SVI and △CVPm in predicting volume responsiveness. SPSS 17.0 software was used for statistic analysis. Results Of 28 patients,8 were responders and 10 were non-responders.In responders after PLR,some hemodynamic variables including ABPs,ABPm and CVPm were significantly increased [(100.1 ± 18.1) vs.(115.9 ±13.1),P=0.005; (68.1±12.4) vs.(77.8±13.0),P=0.03and(7.2±3.4) vs.(10.1±4.1),P=0.03,respectively ].After PLR,the area under curve (AUC) of the ROC curve of △SVI and △CVPm to predict the responsiveness after fluid resuscitation were 0.897 ± 0.059 (95 ％ CI 0.762-1.000) and 0.819±0.081 (95％CI 0.661-0.977),respectively.When the cut-off levels of △SVI and △CVPm were 10.5％ and 12.7％,the sensitivities were 72.2％ and 72.2％,the specificities were 90％ and 80％.Conclusions Changes in △SVI and △CVPm induced by passive leg raising are accurate indices for predicting fluid responsiveness in mechanically ventilated patients with severe sepsis.
