中华危重症医学杂志（电子版）
中華危重癥醫學雜誌（電子版）
중화위중증의학잡지（전자판）
CHINESE JOURNAL OF CRITICAL CARE MEDICINE ( ELECTRONIC EDITON)
2015年
3期
159-164
,共6页
柳开忠%曹永卿%沈珏%柳杰铭
柳開忠%曹永卿%瀋玨%柳傑銘
류개충%조영경%침각%류걸명
休克%通气机,机械%容量反应性%呼气末阻断试验%脉搏轮廓分析技术
休剋%通氣機,機械%容量反應性%呼氣末阻斷試驗%脈搏輪廓分析技術
휴극%통기궤,궤계%용량반응성%호기말조단시험%맥박륜곽분석기술
Shock%Ventilators,mechanical%Fluid responsiveness%End-expiratory occlusion%Pulse contour-derived cardiac index
目的：探讨呼气末阻断试验（EEO）联合脉搏轮廓分析技术（PiCCO）对机械通气-休克患者容量反应性的预测价值。方法取40例机械通气-休克患者，根据补液试验后心脏指数增加值（△CI）是否≥15%分为容量反应组（25例）及无反应组（8例），其中7例患者因EEO时自主呼吸太强而触发呼吸机被排除。观察被动抬腿试验（PLR）、EEO及补液试验前后心率、平均动脉压（MAP）及心脏指数的变化。对PLR、EEO前后与补液试验前后MAP增加值（△MAP）与△CI进行pearson相关分析并绘制ROC曲线分析PLR、EEO预测△MAP及△CI的敏感度及特异度。结果容量反应组患者中PLR、EEO及补液试验后MAP（t=5.021、4.365、4.332，P=0.030、0.042、0.044）、心脏指数水平（t=7.584、7.028、6.727，P=0.008、0.011、0.013）均明显高于试验前。且PLR、EEO前后与补液试验前后△MAP（r=0.383、0.506，P=0.028l、0.003）、△CI（r=0.622、0.629，P均<0.001）均呈正相关。 ROC曲线显示，PLR后MAP和心脏指数变化预测容量反应性的ROC曲线下面积分别是0.777[95%CI（0.624，0.931）]和0.957[95%CI（0.894，0.999）]，EEO后MAP和心脏指数变化预测容量反应性的ROC曲线下面积分别是0.865[95%CI（0.740，0.990）]和0.950[95%CI （0.875，0.998）]。 PLR预测MAP、心脏指数的敏感度分别为66%、78%，特异度均为100%，EEO预测MAP、心脏指数的敏感度分别为76%、82%，特异度均为100%。结论应用EEO联合PiCCO对行机械通气休克患者的容量反应性指标有较好的预测价值。
目的：探討呼氣末阻斷試驗（EEO）聯閤脈搏輪廓分析技術（PiCCO）對機械通氣-休剋患者容量反應性的預測價值。方法取40例機械通氣-休剋患者，根據補液試驗後心髒指數增加值（△CI）是否≥15%分為容量反應組（25例）及無反應組（8例），其中7例患者因EEO時自主呼吸太彊而觸髮呼吸機被排除。觀察被動抬腿試驗（PLR）、EEO及補液試驗前後心率、平均動脈壓（MAP）及心髒指數的變化。對PLR、EEO前後與補液試驗前後MAP增加值（△MAP）與△CI進行pearson相關分析併繪製ROC麯線分析PLR、EEO預測△MAP及△CI的敏感度及特異度。結果容量反應組患者中PLR、EEO及補液試驗後MAP（t=5.021、4.365、4.332，P=0.030、0.042、0.044）、心髒指數水平（t=7.584、7.028、6.727，P=0.008、0.011、0.013）均明顯高于試驗前。且PLR、EEO前後與補液試驗前後△MAP（r=0.383、0.506，P=0.028l、0.003）、△CI（r=0.622、0.629，P均<0.001）均呈正相關。 ROC麯線顯示，PLR後MAP和心髒指數變化預測容量反應性的ROC麯線下麵積分彆是0.777[95%CI（0.624，0.931）]和0.957[95%CI（0.894，0.999）]，EEO後MAP和心髒指數變化預測容量反應性的ROC麯線下麵積分彆是0.865[95%CI（0.740，0.990）]和0.950[95%CI （0.875，0.998）]。 PLR預測MAP、心髒指數的敏感度分彆為66%、78%，特異度均為100%，EEO預測MAP、心髒指數的敏感度分彆為76%、82%，特異度均為100%。結論應用EEO聯閤PiCCO對行機械通氣休剋患者的容量反應性指標有較好的預測價值。
목적：탐토호기말조단시험（EEO）연합맥박륜곽분석기술（PiCCO）대궤계통기-휴극환자용량반응성적예측개치。방법취40례궤계통기-휴극환자，근거보액시험후심장지수증가치（△CI）시부≥15%분위용량반응조（25례）급무반응조（8례），기중7례환자인EEO시자주호흡태강이촉발호흡궤피배제。관찰피동태퇴시험（PLR）、EEO급보액시험전후심솔、평균동맥압（MAP）급심장지수적변화。대PLR、EEO전후여보액시험전후MAP증가치（△MAP）여△CI진행pearson상관분석병회제ROC곡선분석PLR、EEO예측△MAP급△CI적민감도급특이도。결과용량반응조환자중PLR、EEO급보액시험후MAP（t=5.021、4.365、4.332，P=0.030、0.042、0.044）、심장지수수평（t=7.584、7.028、6.727，P=0.008、0.011、0.013）균명현고우시험전。차PLR、EEO전후여보액시험전후△MAP（r=0.383、0.506，P=0.028l、0.003）、△CI（r=0.622、0.629，P균<0.001）균정정상관。 ROC곡선현시，PLR후MAP화심장지수변화예측용량반응성적ROC곡선하면적분별시0.777[95%CI（0.624，0.931）]화0.957[95%CI（0.894，0.999）]，EEO후MAP화심장지수변화예측용량반응성적ROC곡선하면적분별시0.865[95%CI（0.740，0.990）]화0.950[95%CI （0.875，0.998）]。 PLR예측MAP、심장지수적민감도분별위66%、78%，특이도균위100%，EEO예측MAP、심장지수적민감도분별위76%、82%，특이도균위100%。결론응용EEO연합PiCCO대행궤계통기휴극환자적용량반응성지표유교호적예측개치。
Objective To explore the predictive value of end-expiratory occlusion tests (EEO) and pulse contour-derived cardiac index (PiCCO) on fluid responsiveness in mechanically ventilated patients with shock. Methods Forty mechanically ventilated patients with shock were divided into the response group (25 cases) and non-response group (8 cases) according to the cardiac index after fluid resuscitation (△CI)≥15%, and 7 patients were excluded due to the strong spontaneous breathing on EEO. The heart rates, mean arterial pressure (MAP) and cardiac index were determined by PiCCO before and after passive leg raising (PLR), EEO and fluid resuscitation. The changes of MAP (△MAP) and cardiac index during PLR, EEO and fluid resuscitation were analyzed by pearson correlation analysis. The receiver operating characteristic curve was used to predict the △MAP and △CI after PLR and EEO. Results The levels of MAP (t=5.021, 4.365, 4.332, P=0.030, 0.042, 0.044) and cardiac index (t=7.584, 7.028, 6.727, P=0.008, 0.011, 0.013) after PLR, EEO and fluid resuscitation were all higher than those before all the tests. The △MAP (r=0.383, 0.506, P=0.028l, 0.003) and △CI (r=0.622, 0.629, all P<0.001) between PLR, EEO and fluid resuscitation all showed positive interrelation. The area under the receiver operating characteristic curve for MAP and cardiac index in PLR were 0.777 [95%CI (0.624, 0.931)] and 0.957 [95%CI (0.894, 0.999)], respectively. The area under the receiver operating characteristic curve for MAP and cardiac index in EEO were 0.865 [95%CI (0.740, 0.990)] and 0.950 [95%CI (0.875, 0.998)], respectively. The sensitivity of PLR in predicting the MAP and cardiac index were 66%, 78%, and specificity all were 100%. The sensitivity of EEO in predicting the MAP and cardiac index were 76%, 82%, and specificity all were 100%. Conclusion The EEO and PiCCO can predict fluid responsiveness in mechanically ventilated patients with shock.
