CAJ | 학술논문

目的探讨呼气末二氧化碳分压(PETCO2)在被动抬腿试验中的变化及对感染性休克机械通气患者容量反应性的预测价值.方法选择行机械通气治疗的感染性休克患者42例.分别在被动抬腿试验、容量负荷试验后采用脉搏指示连续心输出量(PiCCO)监测患者血流动力学变化,呼气末二氧化碳监测装置监测患者PETCO2.以接受者操作特征曲线(ROC曲线)分析被动抬腿试验后PETCO2的变化对容量反应性的预测价值.结果 (1)42例患者中,24例有容量反应性(有反应组),18例无反应(无反应组).有反应组患者被动抬腿试验后心指数(CI)增加(21.4±12.9)％,PETCO2增加(9.6±4.7)％；无反应组CI[(3.2±1.1) L·min-1·m-1]和PETCO2[(33±4) mm Hg(1 mm Hg =0.133 kPa)]较基线值无变化[(3.0±1.0)L· min-1·m-1;(32±4) mm Hg;P值均＞0.05].有反应组患者被动抬腿试验后CI和PETCO2的变化均高于无反应组[(21.4±12.9)％比(6.4±3.5)％,(9.6±4.7)％比(3.0±2.6)％；P值均＜0.05].(2)相关分析:被动抬腿试验后CI的变化与PETCO2的变化呈正相关(r=0.64,P＜0.05).(3)被动抬腿试验后PETCO2的变化预测容量反应性的ROC曲线下面积为0.900±0.056(95％ CI0.775 ～1.000),以5％为临界值,敏感性为88.0％,特异性88.2％.结论被动抬腿试验后PETCO2的变化可以作为预测感染性休克机械通气患者容量反应性的无创、简便的指标.
목적 탐토호기말이양화탄분압(PETCO2)재피동태퇴시험중적변화급대감염성휴극궤계통기환자용량반응성적예측개치.방법 선택행궤계통기치료적감염성휴극환자42례.분별재피동태퇴시험、용량부하시험후채용맥박지시련속심수출량(PiCCO)감측환자혈류동역학변화,호기말이양화탄감측장치감측환자PETCO2.이접수자조작특정곡선(ROC곡선)분석피동태퇴시험후PETCO2적변화대용량반응성적예측개치.결과 (1)42례환자중,24례유용량반응성(유반응조),18례무반응(무반응조).유반응조환자피동태퇴시험후심지수(CI)증가(21.4±12.9)％,PETCO2증가(9.6±4.7)％；무반응조CI[(3.2±1.1) L·min-1·m-1]화PETCO2[(33±4) mm Hg(1 mm Hg =0.133 kPa)]교기선치무변화[(3.0±1.0)L· min-1·m-1;(32±4) mm Hg;P치균＞0.05].유반응조환자피동태퇴시험후CI화PETCO2적변화균고우무반응조[(21.4±12.9)％비(6.4±3.5)％,(9.6±4.7)％비(3.0±2.6)％；P치균＜0.05].(2)상관분석:피동태퇴시험후CI적변화여PETCO2적변화정정상관(r=0.64,P＜0.05).(3)피동태퇴시험후PETCO2적변화예측용량반응성적ROC곡선하면적위0.900±0.056(95％ CI0.775 ～1.000),이5％위림계치,민감성위88.0％,특이성88.2％.결론 피동태퇴시험후PETCO2적변화가이작위예측감염성휴극궤계통기환자용량반응성적무창、간편적지표.
Objective To test whether the changes of partial end-tidal carbon dioxide pressure (PETCO2) during passive leg raising (PLR) predict fluid responsiveness in mechanically ventilated patients with septic shock.Methods Forty-two mechanically ventilated patients with septic shock admitted from January 2012 to November 2012 were prospectively recruited.Hemodynamic parameters monitored by a pulse indicator continuous cardiac output(PiCCO) device and PETCO2 monitored by an expiratory-CO2 device were studied at baseline,after PLR,and after volume expansion.Fluid responsiveness was defined as an increase in cardiac index (CI) of 15％ or greater after volume expansion.The correlation between PLR-induced CI change (△CIPLR) and PETCO2 (△PETCO2-PLR) was analyzed.The value of △PETCO2-PLR to predict fluid responsiveness was evaluated by receiver operating characteristic (ROC) curves.Results A total of 42 patients were enrolled in this study,of whom,24 had a CI increase of ≥ 15％ after volume expansion (responders).After PLR,CI and PETCO2 were both significantly increased in the response group compared with baseline [(21.4 ± 12.9) ％ of CI and (9.6 ± 4.7) ％ of PETCO2,P ＜ 0.05],while no significant changes were observed (P ＞ 0.05) in the non-response group.Both △CIPLR and △PETCO2-PLR were significantly higher in responder group than in the non-responder group (both P ＜ 0.05).△CI and △PETCO2 after PLR were strongly correlated (r =0.64,P ＜ 0.05).In responders after PLR,the area under ROC curve of △PETCO2-PLR was 0.900 ± 0.056 (95％ CI 0.775-1.000,P ＜ 0.05).An increase of ≥ 5％ in △PETCO2-PLR predicted fluid responsiveness with a sensitivity of 88.0％ and specificity of 88.2％.Conclusions The change of PETCO2 induced by passive leg raising is a non-invasive and easy way to predict fluid responsiveness in mechanically ventilated patients with septic shock.