摘要
目的探讨全心舒张末容量（GEDV）能否作为一项反映心脏前负荷并预测液体反应性的指标，以指导脓毒性休克患者的容量复苏。方法前瞻性地对南京大学医学院附属鼓楼医院2005年11月至2006年11月的12例脓毒性休克患者纳入研究后立即给予容量复苏共33次，容量复苏的方法为贺斯500ml／30min静脉滴注，ITBVI〉850ml／m^2为复苏终点，其他干预措施相同。分别于复苏前和复苏后通过脉搏指示剂连续心排量（PiCCO）监测全心舒张末容量指数（GEDVI）、中心静脉压（CVP）、平均动脉压（MAP）、心脏指数（CI）、每搏输出量指数（SVI）、体循环阻力指数（SVRI）等血流动力学指标，比较容量复苏前后血流动力学指标的变化和相关性。并根据SVI的变化是否大于15％分为容量复苏有反应组和无反应组，比较两组的GEDVI。血液动力学参数前后比较应用非参数检验，相关性分析采用斯皮尔曼等级相关分析。结果容量复苏后MAP、CI、GEDVI、SVI、CVP较复苏前明显升高[（88．18＋8．56和（76．64＋6．55），（3．86＋0．94）和（2．93＋0．71），（737．45＋124．23）和（618．82＋90．36），（61．92＋14．05）和（46．79＋15．61），（16．45＋6．35）和（12．27＋5．82）]，分别为P=0．04，P=0．03，P=0．01，P=0．02，P=0．04，SVRI降低[（1418．45＋443．91）和（1896．82＋759．23）]，且差异具有统计学意义（P=0．03）；GEDVI变化与SVI和cI的变化呈正相关，r=0．767，r=0．724；而CVP和PAWP与SVI相关性差，r=-0．148，r=-0．314；GEDVI的变化与复苏前GEDVI呈负相关，r=-0．595，容量复苏有反应者复苏前GEDVI相对较低，但差异无统计学意义（P〉0．05）。结论与中心静脉压等压力指标相比全心舒张末容量能够更好地反映脓毒性休克患者心脏前负荷，并可预测液体反应性。
Objective To assess the value of global end - diastolic volume （GEDV） as an indicator of cardiac preload and fluid responsiveness patients with in septic shock to guide volume resuscitation. Method Twelve patients with septic shock were intervened volume resuscitation from November 2005 to November 2006. Volume resuscitation was carried out by infusing HES intravenously, until the 1TBVI over 850 ml/m^2 as an end point of volume resuscition besides the routine treatment. The change and correlation of hemodynamic parameters including GEDVI, CVP, MAP, CI, SVI, SVRI were evaluated before and after volume resuscitations by the using thermodilution technique of pulse induced continuous cardiac output （PiCCO）. The volume resuscitation were resulted into two groups according to the change of SVI over 15%, and thereby the GEDVI was compared between two gronps. Nonparametric test was used to compare hemodynamic parameters before and after volume resuscitations, and was used for relation analysis Spearman Rank Correlation. Results After volume loading, some hemodynamic variables including （MAP, CI, GEDVI, SVI and CVP） were elevated, [ （88.18＋ 8.56）and （76.64＋6.55）, P=0.04; （3.86＋0.94） and （2.93＋0.71）, P=0.03; （737.45＋ 124.23） and （618.82＋90.36）, P=0.01; （61.92＋14.05） and （46.79＋15.61）, P=0.02; （16.45＋6.35） and （12.27 ＋ 5.82） P = 0.04, ], but SVRI lowered [ （1418.45 ＋ 443.91 and 1896.82 ＋ 759.23）, and P = 0.03] ; Changes in GEDV index were positively con-elated with changes in SVI and CI （r = 0.767, r = 0.724）, while ehanges in CVP and PAWP were poorly eorrelatedwith SVI, （r=-0.148, r=-0.314）. Changes in GEDV index after volulme loading were negatively correlated with GEDV index volume loading, （ r = - 0.595）, and GEDV index of patients with responsiveness to volume resuscitation was lower than that before volume treatment （ P 〉 0.05）. Conelusions In with patients septic shock, GEDV index is a sensitive indicator of cardiac preload in contrast to press index （CVP）, and it can be used to predict fluid responsiveness.
出处
《中华急诊医学杂志》
CAS
CSCD
2008年第2期137-140,共4页
Chinese Journal of Emergency Medicine
关键词
全心舒张末容积
前负荷
脓毒性休克
中心静脉压
Global end diastolic volume
Preload
Septic shock
Central venous pressure
Volume resuscitation
