每搏变异度、脉搏压变异度的变化评价感染性休克患者容量反应性的临床研究被引量：9

A prospective clinical study of pulse pressure and stroke volume variations in prediction of fluid responsiveness in septic shock patients

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摘要目的通过容量负荷试验评价每搏变异度(stroke volume variation,SVV)、脉搏压变异度(pulse pressure variation,PPV)的变化预测感染性休克机械通气患者的容量反应。方法对解放军105医院重症医学科2013年5月至2015年5月32例感染性休克患者给予容量负荷试验。脉波轮廓温度稀释连续心排量技术(pulse indicator continous cardiac output,Pi CCO)持续监测平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、心输出量(cardiac output,CO)、心脏指数(cardiac index,CI)、每搏输出量(stroke volume,SV)、SVV、PPV。以提高患者CI 15%为目标,△CI≥15%定义为容量反应阳性(有反应组),△CI<15%定义为容量反应阴性(无反应组)。比较两组血流动力学参数前后变化值;并通过绘制受试者工作特征曲线(receiver operating characteristic,ROC)评价上述参数评估容量反应性的价值。结果容量负荷试验前两组间心率、MAP、CVP、CO、SV、SVV、PPV、CI差异均无显著性。容量负荷试验后,有反应组与之前比较差异均有显著性。△SVV和△PPV的ROC曲线下面积分别是0.817、0.857,均高于△SV和△CVP。结论对于机械通气的感染性休克患者,△PPV和△SVV可作为预测容量反应性的血流动力指标。 Objective To investigate the clinical role of changes in pulse pressure and stroke volume variations to evaluate fluid responsiveness in septic shock patients.Method 32 patients with septic shock were studied. Before and after volume challenge, mean arterial pressure （MAP）, central venous pressure（CVP）, cardiac output（CO）, cardiac index （CI）, stroke volume（SV）, stroke volume variation （SVV）, pulse pressure variation（PPV） were monitored by pulse indicated continuous cardiac output （PiCCO）. Responsive group： responders were viewed as an increase in cardiac index （△CI）≥ 15% after fluid challenge. Unresponsive group： non-responders were regarded as a growing in CI〈 15% after volume expansion. The changes in dynamic parameters before and after fluid challenge were analysed. The role of the hemodynamic parameters for fluid responsiveness prediction was assessed by receiver operating characteristic （ROC） curves.Result There were no statistically significant differences in dynamic indices HR, MAP, CVP, CO, SV, SVV, PPV and CI before fluid challenge between the responsive and unresponsive group. The△SVV and△PPV predicted fluid responsiveness with the area under ROC curve （AUC） of 0.817 and 0.857,respectively. They were higher than△SV and△CVP.Conclusion△SVV and△PPV were good indicators of fluid responsiveness in mechanically ventilated patients suffering septic shock.

作者李跃东周翔王亚朋 LI Yue-dong ZHOU Xiang WANG Ya-peng(Department of Critical Care Medicine, 105 Hospital of PLA, Anhui Hefei 230000, China Department of Critical Care Medicine, Peking Union Medical College Hospital Beijing 100730, China)

机构地区解放军中国医学科学院北京协和医学院北京协和医院重症医学科

出处《中国医刊》 CAS 2016年第10期91-94,共4页 Chinese Journal of Medicine

关键词每搏变异度脉搏压变异度感染性休克容量反应性 Stroke volume variation Pulse pressure variation Septic shock Fluid responsiveness

分类号 R631.4 [医药卫生—外科学]

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1徐永昊,刘晓青,何为群,徐远达,陈思蓓,桑岭,肖焕舜,麦岚.定标间隔时间对感染性休克患者脉搏轮廓分析法持续心排血量监测的影响[J].中华危重病急救医学,2014,26(9):615-619. 被引量：8
2Wira CR, Dodge K, Sather J, et al. Meta-analysis of protocolizedgoal-directed hemodynamic optimization for the management ofsevere sepsis and septic shock in the emergency department [J].West J Emerg Med, 2014, 15(1):51-59.
3Marik PE, Baram M, Vahid B. Does the central venous pressurepredict fluid responsiveness? An updated meta-analysis and a pleafor some common sense [J]. Crit Care Med, 2013,41(7):1774-1781.
4Michard F, Teboul JL. Predicting fluid responsiveness in ICUpatients: a critical analysis of the evidence [J]. Chest, 2002,121(6):2000-2008.
5Suarez-Santamaria M, Santolaria F, Perez-Ramirez A, et al.Prognostic value of inflammatory markers (notably cytokinesand procalcitonin), nutritional assessment, and organ function inpatients with sepsis [J]. Eur Cytokine Netw, 2010, 21(1):19-26.
6Jean-Louis Vincent, Max Harry Weil, ScD Hon. Fluid challengerevisited [J]. Crit Care Med, 2006,34(5):1333-1337.
7Mallat J,Meddour M,Durville E, et al. Decrease in pulse pressureand stroke volume variations after mini-fluid challenge accuratelypredicts fluid responsiveness [J]. Br J Anaesth, 2015,115(3):449-456.
8周翔,刘大为,隆云,梅丹,柴文昭,芮曦,王小亭,王郝,张青,郭海凌,李尊柱,李欣.关键点控制干预集束化治疗指南依从性对感染性休克患者预后的影响[J].中华医学杂志,2014,94(13):994-998. 被引量：28
9Feng ZY, Xu X,Zhu SM, et al. Effects of low central venouspressure during preanhepatic phase on blood loss and liver andrenal function in liver transplantation [J]. World J Surg, 2010,34(8):1864-1873.
10Smith SH, Pemer A. Higher vs. lower fluid volume for septicshock: clinical characteristics and outcome in unselectedpatients in a prospective, multicenter cohort [J]. Crit Care, 2012,16(3):R76-R82.

二级参考文献51

1刘琮,刘晓红,何颜霞,林荣枢,刘芙蓉.连续性血液净化治疗在儿童感染性休克中的应用研究[J].中国中西医结合急救杂志,2006,13(3):168-171. 被引量：18
2严静.成人严重感染与感染性休克血流动力学监测与支持指南(2006)[J].中国实用外科杂志,2007,27(1):7-13. 被引量：135
3Rivers E, Nguyen B, Havstad S, et al. Early goal-directedtherapy in the treatment of severe sepsis and septic shock [ J ]. N Engl J Med, 2001,345(19) :1368-1377.
4Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign : international guidelines for management of severe sepsis and septic shock :2008 [ J]. Intensive Care Med ,2008,34 ( 1 ) : 17-60.
5Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign : international guidelines for management of severe sepsis and septic shock :2012[ J]. Crit Care Med,2013,41 (2) :580-637.
6Vicillard-Baron A, Caille V, Charron C, et al. Actual incidence of global left ventricular hypokinesiain adult septic shock[ J ]. Crit Care Med,2008,36 (6) :1701-1706.
7Giraud R, Siegenthaler N, Gayet-Ageron A, et al. ScvO2 as a marker to define fluid responsiveness [ J ]. J Trauma, 2011 , 70 ( 4 ) : 802 - 807.
8Velissaris D,Pierrakos C, Scolletta S, et al. High mixed venous oxy- gen saturation levels do not exclude fluid responsiveness in critically ill septic patients [ J ]. Crit Care,2011,15 (4) : R 177.
9Jozwiak M, Persichini R, Monnet X, et al. Management of myocardial dysfunction in severe sepsis[ J-. Semin Respir Crit Care Med,2011, 32(2) :206-214.
10Ho KM, Harding R, Chamberlain J, et al. A comparison of central and mixed venous oxygen saturation in circulatory failure[ J]. J Cardiothorac Vasc Anesth,2010,24(3) :434-439.