CAJ | 학술논문

目的探讨无创心排监测技术(NICOM)引导被动抬腿试验(PLR)预测老年脓毒症患者液体反应性的价值.方法采用前瞻性自身对照的临床研究方法,选浙江医院重症医学科老年脓毒症患者31例,先行PLR,然后进行补液试验.采用NICOM监测整个试验过程,记录PLR前后及补液前后心排血量(CO)、每搏输出量(SV)、心率、每搏输出量变异率(Svv)、无创血压、胸腔内总容量(TFC)的变化,记录PLR后CO变化率(ΔCOPLR)、补液后CO变化率(ΔCOvE).将补液后CO增加≥10％定义为有液体反应性,CO增加＜10％或未增加定义为无液体反应性.采用ROC曲线评价ΔCOPLR和SVV对液体反应性的预测价值.结果 (1)31例老年脓毒症患者共进行100例次试验,其中有液体反应性者28例次,无液体反应性者72例次.(2)与试验前比,有液体反应性者PLR及补液后CO[(5.11 ±2.10) L/min比(5.91±2.45) L/min;(5.06±2.06) L/min比(5.77 ±2.47) L/min;P值均＜0.05]、SV[(59.61±18.22)ml比(69.29 ±21.32) ml; (60.10±15.95)ml比(70.06±17.96) ml;P值均＜0.05]增加.(3)ΔCOPLR与ΔCOvE有相关性(r=0.819,P=0.001),补液前SVV与ΔCOvE无相关性(r=-0.218,P=0.059).(4)以ΔCOPLR预测患者液体反应性,AUCROC为0.859;以SVV预测患者液体反应性,AUCROC为0.459.以ΔCOPLR≥10％预测液体反应性敏感性为85％,特异性为83％.结论 NICOM引导PLR能准确评估老年脓毒症患者液体反应性,是一种简便有效的方法.
목적 탐토무창심배감측기술(NICOM)인도피동태퇴시험(PLR)예측노년농독증환자액체반응성적개치.방법 채용전첨성자신대조적림상연구방법,선절강의원중증의학과노년농독증환자31례,선행PLR,연후진행보액시험.채용NICOM감측정개시험과정,기록PLR전후급보액전후심배혈량(CO)、매박수출량(SV)、심솔、매박수출량변이솔(Svv)、무창혈압、흉강내총용량(TFC)적변화,기록PLR후CO변화솔(ΔCOPLR)、보액후CO변화솔(ΔCOvE).장보액후CO증가≥10％정의위유액체반응성,CO증가＜10％혹미증가정의위무액체반응성.채용ROC곡선평개ΔCOPLR화SVV대액체반응성적예측개치.결과 (1)31례노년농독증환자공진행100례차시험,기중유액체반응성자28례차,무액체반응성자72례차.(2)여시험전비,유액체반응성자PLR급보액후CO[(5.11 ±2.10) L/min비(5.91±2.45) L/min;(5.06±2.06) L/min비(5.77 ±2.47) L/min;P치균＜0.05]、SV[(59.61±18.22)ml비(69.29 ±21.32) ml; (60.10±15.95)ml비(70.06±17.96) ml;P치균＜0.05]증가.(3)ΔCOPLR여ΔCOvE유상관성(r=0.819,P=0.001),보액전SVV여ΔCOvE무상관성(r=-0.218,P=0.059).(4)이ΔCOPLR예측환자액체반응성,AUCROC위0.859;이SVV예측환자액체반응성,AUCROC위0.459.이ΔCOPLR≥10％예측액체반응성민감성위85％,특이성위83％.결론 NICOM인도PLR능준학평고노년농독증환자액체반응성,시일충간편유효적방법.
Objective To investigate the value of bioreactance-based passive leg raising(PLR) test predicting fluid responsiveness of elderly patients with sepsis.Methods This prospective and self-controlled clinical study included 31 elderly patients with sepsis in the Department of Intensive Care Medicine of Zhejiang Hospital.Hemodynamic parameters including cardiac output (CO),stroke volume variation (SVV) were continuously recorded by bioreactance-based device (noninvasive cardiac output monitoring,NICOM) before and after PLR and volume expansion (VE) test.Patients were defined as responders if CO increased ≥ 10％ after VE.Results A total of 100 PLR and VE tests in these 31 patients were evaluated.In 28 responders,CO[(5.11 ±2.10) L/min vs (5.91 ±2.45) L/min,P ＜0.05;(5.06 ±2.06) L/min vs (5.77±2.47) L/min,P ＜0.05] and SV [(59.61 ±18.22) ml vs (69.29 ±21.32) ml,P＜0.05; (60.10 ± 15.95) ml vs (70.06 ± 17.96) ml,P ＜0.05] were obviously increased both after PLR and VE.The ΔCO after PLR(ΔCOPLR) and ΔCOVE was highly correlated (r =0.819,P =0.001) while the SVV before VE and ΔCOVE was uncorrelated (r =-0.218,P =0.059).The areas under the ROC curve of ΔCOPLR,SVV predicting fluid responsiveness were 0.859 and 0.459 respectively.The ΔCOPLR ≥ 10％ was found to predict fluid responsiveness with a sensitivity and specificity of 85％ and 83％ respectively.Conclusion Compared with SVV,PLR test is a simple,effective method for accurately predicting fluid responsiveness of elderly patients with sepsis.