中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2013年
1期
32-35
,共4页
液体反应性%平均动脉压%脓毒性休克
液體反應性%平均動脈壓%膿毒性休剋
액체반응성%평균동맥압%농독성휴극
Fluid responsiveness%Mean arterial pressure%Septic shock
目的 探讨平均动脉压(MAP)对脓毒性休克患者液体反应性的预测价值.方法 采用回顾性分析方法,选择2011年6月至2012年2月南京大学医学院附属鼓楼医院重症监护病房(ICU)收治的68例脓毒性休克患者,所有患者均实施容量负荷试验,监测容量复苏前后心率(HR)、MAP、收缩压(SBP)、舒张压(DBP)、脉压(PP)、中心静脉压(CVP)等,并通过脉搏指示连续心排血量(PiCCO)技术监测心排血指数(CI)、胸腔内血容量指数(ITBVI)、全身血管阻力指数(SVRI)、血管外肺水指数(EVLWI)等血流动力学指标.根据容量复苏后CI的变化(△CI％)分为液体有反应组(△CI％≥10％)和无反应组(△CI％＜10％),观察两组容量复苏前后血流动力学指标的变化；根据基础MAP水平将患者分为低MAP组(LMAP,MAP≤65 mm Hg,1 mm Hg=0.133 kPa)和高MAP组(HMAP,MAP＞65 mm Hg),比较容量复苏前后两亚组各血流动力学指标的变化及MAP变化(△MAP％)与△CI％的相关性.结果 68例患者中液体有反应者44例,占64.7％.有反应组患者容量负荷试验后SBP、DBP、MAP、PP、CI、CVP和ITBVI较试验前明显升高[SBP (mm Hg):126.5±23.8比110.7±20.2,DBP(mm Hg):58.1±14.8比52.8±13.5,MAP(mm Hg):80.3±19.2比70.1±15.8,PP(mm Hg):68.2±18.7比58.0±15.8,CI (ml·s-1·m-2):70.0±21.7比53.3±20.0,CVP (mm Hg):13.0±4.5比10.2±4.4,ITBVI (ml/m2):909.1±248.7比773.5±220.7,均P＜0.01],SVRI (kPa·s· L-1· m-2)明显降低(130.9±47.7比157.1±59.1,P＜0.01),HR和EVLWI无明显变化.68例患者容量复苏后△MAP％与△CI％无显著相关性(r=0.266,P=0.054),而LMAP亚组(39例)△MAP％与△CI％呈正相关(r=0.473,P=0.03),△MAP％受试者工作特征曲线(ROC曲线)下面积(AUC)为0.763,95％可信区间(95％CI)0.554 ～ 0.973,P=0.231；HMAP亚组(29例)△MAP％与△CI％无显著相关性(r=-0.088,P=0.633).结论 脓毒性休克患者血压处于低水平时(MAP≤65 mm Hg),MAP可作为评估容量复苏时液体反应性的指标之一.
目的 探討平均動脈壓(MAP)對膿毒性休剋患者液體反應性的預測價值.方法 採用迴顧性分析方法,選擇2011年6月至2012年2月南京大學醫學院附屬鼓樓醫院重癥鑑護病房(ICU)收治的68例膿毒性休剋患者,所有患者均實施容量負荷試驗,鑑測容量複囌前後心率(HR)、MAP、收縮壓(SBP)、舒張壓(DBP)、脈壓(PP)、中心靜脈壓(CVP)等,併通過脈搏指示連續心排血量(PiCCO)技術鑑測心排血指數(CI)、胸腔內血容量指數(ITBVI)、全身血管阻力指數(SVRI)、血管外肺水指數(EVLWI)等血流動力學指標.根據容量複囌後CI的變化(△CI％)分為液體有反應組(△CI％≥10％)和無反應組(△CI％＜10％),觀察兩組容量複囌前後血流動力學指標的變化；根據基礎MAP水平將患者分為低MAP組(LMAP,MAP≤65 mm Hg,1 mm Hg=0.133 kPa)和高MAP組(HMAP,MAP＞65 mm Hg),比較容量複囌前後兩亞組各血流動力學指標的變化及MAP變化(△MAP％)與△CI％的相關性.結果 68例患者中液體有反應者44例,佔64.7％.有反應組患者容量負荷試驗後SBP、DBP、MAP、PP、CI、CVP和ITBVI較試驗前明顯升高[SBP (mm Hg):126.5±23.8比110.7±20.2,DBP(mm Hg):58.1±14.8比52.8±13.5,MAP(mm Hg):80.3±19.2比70.1±15.8,PP(mm Hg):68.2±18.7比58.0±15.8,CI (ml·s-1·m-2):70.0±21.7比53.3±20.0,CVP (mm Hg):13.0±4.5比10.2±4.4,ITBVI (ml/m2):909.1±248.7比773.5±220.7,均P＜0.01],SVRI (kPa·s· L-1· m-2)明顯降低(130.9±47.7比157.1±59.1,P＜0.01),HR和EVLWI無明顯變化.68例患者容量複囌後△MAP％與△CI％無顯著相關性(r=0.266,P=0.054),而LMAP亞組(39例)△MAP％與△CI％呈正相關(r=0.473,P=0.03),△MAP％受試者工作特徵麯線(ROC麯線)下麵積(AUC)為0.763,95％可信區間(95％CI)0.554 ～ 0.973,P=0.231；HMAP亞組(29例)△MAP％與△CI％無顯著相關性(r=-0.088,P=0.633).結論 膿毒性休剋患者血壓處于低水平時(MAP≤65 mm Hg),MAP可作為評估容量複囌時液體反應性的指標之一.
목적 탐토평균동맥압(MAP)대농독성휴극환자액체반응성적예측개치.방법 채용회고성분석방법,선택2011년6월지2012년2월남경대학의학원부속고루의원중증감호병방(ICU)수치적68례농독성휴극환자,소유환자균실시용량부하시험,감측용량복소전후심솔(HR)、MAP、수축압(SBP)、서장압(DBP)、맥압(PP)、중심정맥압(CVP)등,병통과맥박지시련속심배혈량(PiCCO)기술감측심배혈지수(CI)、흉강내혈용량지수(ITBVI)、전신혈관조력지수(SVRI)、혈관외폐수지수(EVLWI)등혈류동역학지표.근거용량복소후CI적변화(△CI％)분위액체유반응조(△CI％≥10％)화무반응조(△CI％＜10％),관찰량조용량복소전후혈류동역학지표적변화；근거기출MAP수평장환자분위저MAP조(LMAP,MAP≤65 mm Hg,1 mm Hg=0.133 kPa)화고MAP조(HMAP,MAP＞65 mm Hg),비교용량복소전후량아조각혈류동역학지표적변화급MAP변화(△MAP％)여△CI％적상관성.결과 68례환자중액체유반응자44례,점64.7％.유반응조환자용량부하시험후SBP、DBP、MAP、PP、CI、CVP화ITBVI교시험전명현승고[SBP (mm Hg):126.5±23.8비110.7±20.2,DBP(mm Hg):58.1±14.8비52.8±13.5,MAP(mm Hg):80.3±19.2비70.1±15.8,PP(mm Hg):68.2±18.7비58.0±15.8,CI (ml·s-1·m-2):70.0±21.7비53.3±20.0,CVP (mm Hg):13.0±4.5비10.2±4.4,ITBVI (ml/m2):909.1±248.7비773.5±220.7,균P＜0.01],SVRI (kPa·s· L-1· m-2)명현강저(130.9±47.7비157.1±59.1,P＜0.01),HR화EVLWI무명현변화.68례환자용량복소후△MAP％여△CI％무현저상관성(r=0.266,P=0.054),이LMAP아조(39례)△MAP％여△CI％정정상관(r=0.473,P=0.03),△MAP％수시자공작특정곡선(ROC곡선)하면적(AUC)위0.763,95％가신구간(95％CI)0.554 ～ 0.973,P=0.231；HMAP아조(29례)△MAP％여△CI％무현저상관성(r=-0.088,P=0.633).결론 농독성휴극환자혈압처우저수평시(MAP≤65 mm Hg),MAP가작위평고용량복소시액체반응성적지표지일.
Objective To assess the value of mean arterial pressure (MAP) as an indicator for fluid responsiveness in patients with septic shock.Methods A retrospective analysis of clinical data of 68 patients with septic shock receiving volume resuscitation in intensive care unit (ICU) of Drum-tower Hospital Affiliated to Medical School of Nanjing University from June 2011 to February 2012 was conducted.The changes in heart rate (HR),MAP,systolic arterial pressure (SBP),diastolic arterial pressure (DBP),pluse pressure (PP),central venous pressure (CVP) were recorded before and after volume resuscitations.Cardiac index (CI),intrathoracic blood volume index (ITBVI),systemic vessel resistance index (SVRI) and extravascular lung water index (EVLWI) were evaluated by using the thermodilution technique of pulse induced continuous cardiac output (PiCCO).All the patients were divided into two groups,responded group (△CI％ ≥ 10％) and the unresponded group (△CI％＜ 10％),according to the change in CI (△CI％).Then the patients were divided into two subgroups,namely low MAP group(LMAP,MAP≤65 mm Hg,1 mm Hg =0.133 kPa) and high MAP group (HMAP,MAP ＞ 65 mm Hg),according to the initial value of MAP.Then compared the changes in hemodynamic variables before and after volume resuscitation in each subgroup and assess the correlation between the changes in MAP (△MAP％) and △CI％.Results Forty-four (64.7％) patients responded to the fluid challenge according to the predetermined criteria,SBP,DBP,MAP,PP,CI,CVP,ITBVI were increased significantly [SBP (mmHg):126.5±23.8 vs.110.7±20.2,DBP (mmHg):58.1±14.8 vs.52.8 ±13.5,MAP(mmHg):80.3±19.2vs.70.1±15.8,PP (mmHg):68.2±18.7vs.58.0±15.8,CI (ml·s-1·m-2):70.0±21.7vs.53.3±20.0,CVP (mmHg):13.0±4.5 vs.10.2±4.4,ITBVI (ml/m2):909.1±248.7 vs.773.5±220.7,all P＜0.01],and SVRI (kPa·s·L-1·m-2) was decreased significantly (130.9 ± 47.7 vs.157.1 ± 59.1,P＜0.01).HR and EVLWI did not change significantly.There was no significant correlation between △MAP％ and △CI％ in all the patients (r=0.266,P=0.054).In the sub-group of LMAP (n =39),△MAP％ was positively correlated with △CI％(r=0.473,P=0.03),the under the receiver operating characteristic curve (ROC curve,AUC) was 0.763,95％confidence interval (95％CI) 0.554-0.973,P=0.231.However,there was no significant correlation between the △MAP％ and △CI％ (r=-0.088,P=0.633) in the sub-group of HMAP (n=29).Conclusion MAP can be used as an indicator of fluid responsiveness when the initial value of MAP was at a relative low level (MAP ≤65 mm Hg) in patients with septic shock.
