中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
41期
2935-2938
,共4页
于大兴%翁利%彭劲民%杜斌
于大興%翁利%彭勁民%杜斌
우대흥%옹리%팽경민%두빈
输液疗法%血压%中心静脉压
輸液療法%血壓%中心靜脈壓
수액요법%혈압%중심정맥압
Fluid therapy%Blood pressure%Central venous pressure
目的 观察容量负荷试验前后生理指标改变对试验结果的判断价值.方法 回顾分析39例休克患者共86次容量负荷试验的资料.以心输出量(CO)升高超过10%为试验阳性标准,同时记录快速补液前后血压、心率、中心静脉压数值.结果 容量负荷试验阳性组收缩压差值、舒张压差值、脉压差值(△PP)和平均动脉压差值明显高于试验阴性组.Logistic回归分析显示,△PP是容量负荷试验的预测指标(比数比1.100,95%可信区间为1.037～1.167).以△PP 5 mm Hg(1 mm Hg=0.133 kPa)为判断容量负荷试验阳性标准,敏感性78.4%,特异性75.7%,阳性预期值76.3%,阴性预期值77.8%.△PP与心输出量差值(△CO)正相关(r=0.417,P＜0.001).结论 临床常用监测指标如CVP和HR不能预测容量反应性,而容量负荷试验前后△PP有一定的预测价值.
目的 觀察容量負荷試驗前後生理指標改變對試驗結果的判斷價值.方法 迴顧分析39例休剋患者共86次容量負荷試驗的資料.以心輸齣量(CO)升高超過10%為試驗暘性標準,同時記錄快速補液前後血壓、心率、中心靜脈壓數值.結果 容量負荷試驗暘性組收縮壓差值、舒張壓差值、脈壓差值(△PP)和平均動脈壓差值明顯高于試驗陰性組.Logistic迴歸分析顯示,△PP是容量負荷試驗的預測指標(比數比1.100,95%可信區間為1.037～1.167).以△PP 5 mm Hg(1 mm Hg=0.133 kPa)為判斷容量負荷試驗暘性標準,敏感性78.4%,特異性75.7%,暘性預期值76.3%,陰性預期值77.8%.△PP與心輸齣量差值(△CO)正相關(r=0.417,P＜0.001).結論 臨床常用鑑測指標如CVP和HR不能預測容量反應性,而容量負荷試驗前後△PP有一定的預測價值.
목적 관찰용량부하시험전후생리지표개변대시험결과적판단개치.방법 회고분석39례휴극환자공86차용량부하시험적자료.이심수출량(CO)승고초과10%위시험양성표준,동시기록쾌속보액전후혈압、심솔、중심정맥압수치.결과 용량부하시험양성조수축압차치、서장압차치、맥압차치(△PP)화평균동맥압차치명현고우시험음성조.Logistic회귀분석현시,△PP시용량부하시험적예측지표(비수비1.100,95%가신구간위1.037～1.167).이△PP 5 mm Hg(1 mm Hg=0.133 kPa)위판단용량부하시험양성표준,민감성78.4%,특이성75.7%,양성예기치76.3%,음성예기치77.8%.△PP여심수출량차치(△CO)정상관(r=0.417,P＜0.001).결론 림상상용감측지표여CVP화HR불능예측용량반응성,이용량부하시험전후△PP유일정적예측개치.
Objective To investigate the clinical values of blood pressure, heart rate and central venous pressure before and after fluid challenge to predict volume responsiveness. Methods A total of 86 fluid challenges in 39 patients with hemodynamic monitoring were retrospectively analyzed. Fluid challenges were separated into responder group and control group based on whether a 10% increase in cardiac output was achieved by fluid challenge. Such physiologic variables as systolic blood pressure(SBP), diastolic blood pressure(DBP), pulse pressure(PP), mean arterial pressure(MAP), heart rate(HR)and central venous pressure(CVP)were recorded before and after fluid challenges. Results △SBP, △DBP, △PP and △MAP before and after fluid challenge were significantly higher in responder group than control group.Logistic regression analysis identified △PP as the only independent predictor of fluid responsiveness(OR1. 100, 95%CI 1. 037-1. 167). Fluid responsiveness was predicted by △PP ≥5 mm Hg with sensitivity 78.4%, specificity 75.7%, positive predict value 76. 3% and negative predict value 77.8%. Only △PP correlated with △CO by Pearson correlation analysis(r=0.417, P＜0.001). Conclusion △PP before and after fluid challenge can predict volume responsiveness while HR and CVP can not.
