摘要
目的 观察容量负荷试验前后生理指标改变对试验结果的判断价值.方法 回顾分析39例休克患者共86次容量负荷试验的资料.以心输出量（CO）升高超过10%为试验阳性标准,同时记录快速补液前后血压、心率、中心静脉压数值.结果 容量负荷试验阳性组收缩压差值、舒张压差值、脉压差值（△PP）和平均动脉压差值明显高于试验阴性组.Logistic回归分析显示,△PP是容量负荷试验的预测指标（比数比1.100,95%可信区间为1.037～1.167）.以△PP 5 mm Hg（1 mm Hg=0.133 kPa）为判断容量负荷试验阳性标准,敏感性78.4%,特异性75.7%,阳性预期值76.3%,阴性预期值77.8%.△PP与心输出量差值（△CO）正相关（r=0.417,P＜0.001）.结论 临床常用监测指标如CVP和HR不能预测容量反应性,而容量负荷试验前后△PP有一定的预测价值.
Objective To investigate the clinical values of blood pressure, heart rate and central venous pressure before and after fluid challenge to predict volume responsiveness. Methods A total of 86 fluid challenges in 39 patients with hemodynamic monitoring were retrospectively analyzed. Fluid challenges were separated into responder group and control group based on whether a 10% increase in cardiac output was achieved by fluid challenge. Such physiologic variables as systolic blood pressure（SBP）, diastolic blood pressure（DBP）, pulse pressure（PP）, mean arterial pressure（MAP）, heart rate（HR）and central venous pressure（CVP）were recorded before and after fluid challenges. Results △SBP, △DBP, △PP and △MAP before and after fluid challenge were significantly higher in responder group than control group.Logistic regression analysis identified △PP as the only independent predictor of fluid responsiveness（OR1. 100, 95%CI 1. 037-1. 167）. Fluid responsiveness was predicted by △PP ≥5 mm Hg with sensitivity 78.4%, specificity 75.7%, positive predict value 76. 3% and negative predict value 77.8%. Only △PP correlated with △CO by Pearson correlation analysis（r=0.417, P〈0.001）. Conclusion △PP before and after fluid challenge can predict volume responsiveness while HR and CVP can not.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第41期2935-2938,共4页
National Medical Journal of China
关键词
输液疗法
血压
中心静脉压
Fluid therapy
Blood pressure
Central venous pressure
