CAJ | 학술논문

目的：重症监护室（ ICU）内充分的液体复苏是治疗脓毒症和低血量休克的关键。探讨床边超声监测股动脉峰值血流速度变异率（ΔPeak -FA ）结合被动抬腿试验（ passive leg raising， PLR）对容量负荷试验判断的准确性和可行性。方法前瞻性分析2013-03～2013-10我院ICU机械通气并存在自主呼吸的55例患者。通过超声监测基线、被动抬腿试验和容量负荷（ VE，6％羟乙基淀粉500 mL于30 min输完）前后血流动力学状态，并以容量负荷后每搏输出量增加（ΔSVVE）≥15％为容量反应阳性的金标准，分析股动脉峰值血流速度变异率，ROC曲线灵敏度、特异度和似然比，以评价此研究的临床可行性。结果50例患者中27例容量负荷试验有反应，23例容量负荷试验无反应，PLR前后ΔPeak-FA（ΔPeak-FAPLR）与ΔSVVE具有较好的正相关性（r＝0．709，P＜0.01），ΔPeak -FAPLR的ROC曲线评估预测容量反应曲线下面积（AUC）0.858±0．054（P＜0．01）。ΔPeak-FAPLR＞13％为诊断容量反应的分界点，敏感度是67％，特异度是96％；阳性预测值是94％，阴性预测值是74％。结论床旁超声测量PLR前后股动脉峰值血流速度变异率能在一定程度上准确地评估ICU患者容量状态，这一手段容易被ICU医师掌握，可指导临床治疗。
목적：중증감호실（ ICU）내충분적액체복소시치료농독증화저혈량휴극적관건。탐토상변초성감측고동맥봉치혈류속도변이솔（ΔPeak -FA ）결합피동태퇴시험（ passive leg raising， PLR）대용량부하시험판단적준학성화가행성。방법전첨성분석2013-03～2013-10아원ICU궤계통기병존재자주호흡적55례환자。통과초성감측기선、피동태퇴시험화용량부하（ VE，6％간을기정분500 mL우30 min수완）전후혈류동역학상태，병이용량부하후매박수출량증가（ΔSVVE）≥15％위용량반응양성적금표준，분석고동맥봉치혈류속도변이솔，ROC곡선령민도、특이도화사연비，이평개차연구적림상가행성。결과50례환자중27례용량부하시험유반응，23례용량부하시험무반응，PLR전후ΔPeak-FA（ΔPeak-FAPLR）여ΔSVVE구유교호적정상관성（r＝0．709，P＜0.01），ΔPeak -FAPLR적ROC곡선평고예측용량반응곡선하면적（AUC）0.858±0．054（P＜0．01）。ΔPeak-FAPLR＞13％위진단용량반응적분계점，민감도시67％，특이도시96％；양성예측치시94％，음성예측치시74％。결론상방초성측량PLR전후고동맥봉치혈류속도변이솔능재일정정도상준학지평고ICU환자용량상태，저일수단용역피ICU의사장악，가지도림상치료。
Objective Adequate fluid resuscitation is the key to the therapy of sepsis and other forms of septic shock commonly encountered in the intensive care unit (ICU).The present study aims to investigate the feasibility and accuracy of beside ultrasound measuring the variation of femoral artery peak velocity (ΔPeak-FA) combined with passive leg raising ( PLR) experiment in the evaluation of fluid responsiveness .Methods During a 7 -month period from January to July 2013 , we prospectively studied 55 patients enrolled into our ICU with spontaneous breathing ( SB ) during mechanical ventilation.We assessed hemodynamic status at baseline , after PLR, and after volume expansion (VE, 500 ml hydroxyethyl starch over 30 mins) by ultrasound.Patients were classified as responders if the variation of SV increase (ΔSVVE)≥15% after 500 mL volume expansion as the gold standard of fluid responsiveness .By analyzed the sensitivity , specificity and likelihood ratios of receiver operating characteristic ( ROC) curves of ΔPeak-FA, the feasibility and the accuracy of the diagnosis clinical study in predicting volume responsiveness was estimated .Results Among them after VE , ΔSVVE≥15%in 27 patients defined as responders and the rest 23 did not respond.After PLR, the area under the ROC of ΔPeak -FA was 0.858 ±0.054(P <0.01), and the ΔPeak -FA >13% predicted fluid responsiveness with a sensitivity of 67%, specificity of 96%, positive predictive value of 94%, and negative predictive value of 74%, respectively .Conclusion Measurement of ΔPeak -FA combined with PLR experiment with bedside ultrasound can accurately estimate the fluid status of the patient in ICU, and it is easy to be performed by the residents of ICU .In the future, it can be used in clinical practice.