CAJ | 학술논문

目的脉搏血氧波形振幅变异率(respiratory variations in the pulse oximetry plethysmographic waveform amplitude,△POP)作为容量反应的动态评估指标正在被广泛研究.本研究旨在探讨△POP在急诊感染性休克患者的容量反应评估中的作用.方法本实验前瞻性地研究2010年10月到2011年10月北京协和医院急诊科抢救室和EICU收治的28例感染性休克患者,记录所有患者在扩容(羟乙基淀粉万汶500 mL)前后的各项血流动力学参数,如心输出量、每搏输出量变异率(stroke volume variation,SVV)和△POP等,容量反应阳性定义为扩容后患者每搏输出量较输液前增加15％以上.结果容量反应阳性患者扩容前的△POP较容量反应阴性患者高(P＜0.01).扩容前的SVV和△POP两指标之间存在显著的正相关关系,Spearman相关系数为0.900 (P＜0.01).结论 △POP对急诊感染性休克患者的容量反应预测准确性较高,和SVV有很好的相关性,优于CI、SVRI、CVP等静态指标,值得进一步研究.
목적 맥박혈양파형진폭변이솔(respiratory variations in the pulse oximetry plethysmographic waveform amplitude,△POP)작위용량반응적동태평고지표정재피엄범연구.본연구지재탐토△POP재급진감염성휴극환자적용량반응평고중적작용.방법 본실험전첨성지연구2010년10월도2011년10월북경협화의원급진과창구실화EICU수치적28례감염성휴극환자,기록소유환자재확용(간을기정분만문500 mL)전후적각항혈류동역학삼수,여심수출량、매박수출량변이솔(stroke volume variation,SVV)화△POP등,용량반응양성정의위확용후환자매박수출량교수액전증가15％이상.결과 용량반응양성환자확용전적△POP교용량반응음성환자고(P＜0.01).확용전적SVV화△POP량지표지간존재현저적정상관관계,Spearman상관계수위0.900 (P＜0.01).결론 △POP대급진감염성휴극환자적용량반응예측준학성교고,화SVV유흔호적상관성,우우CI、SVRI、CVP등정태지표,치득진일보연구.
Objective Respiratory variations in the pulse oximetry plethysmographic waveform amplitude (△POP) have been popularly studied as a dynamic indicators for fluid responsiveness assessment.The authors hypothesized that △POP can indicate fluid responsiveness in septic shock patient in emergency department.Methods A prospective study of 28 patients with septic shock was carried out in Emergency Room and Emergency Intensive Care Unit from 1 October,2010 to 30 September,2011.Hemodynamic data including cardiac index,stroke volume Variation (SVV) and △POP were recorded before and after volume expansion treatment.Fluid responsiveness was defined as an increase in cardiac index of 15％ or greater.Results Changes in △POP after volume expansion were greater in responders than that in non-responders (P ＜ 0.01).There was a significant relation between △POP and SVV before volume expansion (r =0.900,P ＜ 0.0001).Conclusions △POPcan indicate fluid responsiveness non-invasively in septic shock patient in emergency department.This marker has potential clinical application with high sensitivity and reliability.