CAJ | 학술논문

目的观察被动抬腿试验(PLR)预测严重感染和感染性休克患者容量反应性的价值.方法采用前瞻性观察性研究方法,选择2009年2月至2010年1月北京大学深圳医院重症监护病房(ICU)的30例严重感染和感染性休克患者.在患者平卧位、PLR期间和扩容后进行血流动力学监测,用超声心排血量监测仪无创监测每搏量(SV)、心排血量(CO)、外周血管阻力(SVR)等血流动力学指标,持续监测有创动脉血压、中心静脉压(CVP).将扩容后SV增加值(△SV)≥15%定义为有容量反应性,用受试者工作特征曲线(ROC曲线)评价PLR预测容量反应性的价值.结果扩容后有15例患者有容量反应.PLR期间无反应组和有反应组患者CVP(cm H2O,1 cm H2O=0.098 kPa)均较平卧位时增加(13.6±6.6比12.1±6.0,11.9±5.5比10.8±5.2,均P＜0.01);有反应组PLR期间△SV明显高于无反应组[(16.6±5.5)%比(3.8±8.2)%,P=0.000];PLR期间△SV与扩容后△SV呈显著正相关(r=0.681,P=0.000);PLR预测容量反应性的ROC曲线下面积(AUC)为0.944±0.039(P=0.000),PLR期间△SV＞11%预测容量反应性的敏感性和特异性分别为86.7%和93.3%,阳性预测率和阴性预测率分别为92.9%和87.5%.结论 PLR能精确预测严重感染和感染性休克患者的容量反应性,可指导临床治疗.
목적 관찰피동태퇴시험(PLR)예측엄중감염화감염성휴극환자용량반응성적개치.방법 채용전첨성관찰성연구방법,선택2009년2월지2010년1월북경대학심수의원중증감호병방(ICU)적30례엄중감염화감염성휴극환자.재환자평와위、PLR기간화확용후진행혈류동역학감측,용초성심배혈량감측의무창감측매박량(SV)、심배혈량(CO)、외주혈관조력(SVR)등혈류동역학지표,지속감측유창동맥혈압、중심정맥압(CVP).장확용후SV증가치(△SV)≥15%정의위유용량반응성,용수시자공작특정곡선(ROC곡선)평개PLR예측용량반응성적개치.결과 확용후유15례환자유용량반응.PLR기간무반응조화유반응조환자CVP(cm H2O,1 cm H2O=0.098 kPa)균교평와위시증가(13.6±6.6비12.1±6.0,11.9±5.5비10.8±5.2,균P＜0.01);유반응조PLR기간△SV명현고우무반응조[(16.6±5.5)%비(3.8±8.2)%,P=0.000];PLR기간△SV여확용후△SV정현저정상관(r=0.681,P=0.000);PLR예측용량반응성적ROC곡선하면적(AUC)위0.944±0.039(P=0.000),PLR기간△SV＞11%예측용량반응성적민감성화특이성분별위86.7%화93.3%,양성예측솔화음성예측솔분별위92.9%화87.5%.결론 PLR능정학예측엄중감염화감염성휴극환자적용량반응성,가지도림상치료.
Objective To evaluate the role of passive leg raising(PLR)test in predicting volume responsiveness in severe sepsis and septic shock patients. Methods Thirty severe sepsis and septic shock patients in intensive care unit(ICU)of Peking University Shenzhen Hospital were prospectively observed from February 2009 to January 2010. The hemodynamics including stroke volume(SV), cardiac output (CO)and systemic vascular resistance(SVR)were measured non-invasively by ultrasonic cardiac output monitor(USCOM)device in the supine position, during PLR and after volume expansion(VE), and invasive arterial blood pressure and central venous pressure(CVP)were monitored consecutively. Responders were defined by the appearance of an increase in SV(△SV)≥15% after VE. The role of PLR for predicting volume responsiveness was evaluated by receiver operating characteristic(ROC)curves. Results The CVP (cm H2O, 1 cm H2O=0. 098 kPa)during PLR was increased compared with that at supine position in both responder group(n= 15)and non-responder group(n= 15, 13. 6± 6. 6 vs. 12. 1 ± 6. 0, 11.9± 5.5 vs.10. 8±5.2, both P＜0. 01). △SV was higher in responder group than in non-responder group during PLR [(16. 6±5.5)% vs.(3. 8±8. 2)%, P=0. 000]. △SV during PLR was highly correlated to △SV after VE (r=0. 681, P=0. 000). The area under the ROC curve(AUC)for PLR predicting volume responsiveness was 0. 944±0. 039(P=0. 000). The △SV＞11% during PLR was found to predict volume responsiveness with a sensitivity of 86. 7%, specificity of 93. 3 %, positive predictive value of 92. 9 % and negative predictive value of 87.5%. Conclusion PLR can be used generally to predict volume responsiveness accurately in severe sepsis and septic shock patients, and it can be used to direct clinical practice.