目的探讨经皮氧分压（transcutaneous partial pressure of oxygen，PtcO2）在被动抬腿试验（passive leg raising，PLR）评估容量反应性中的价值。方法选择2014-01～2015—12需行液体容量评估的机械通气患者89例，在PLR前后采用脉搏指...目的探讨经皮氧分压（transcutaneous partial pressure of oxygen，PtcO2）在被动抬腿试验（passive leg raising，PLR）评估容量反应性中的价值。方法选择2014-01～2015—12需行液体容量评估的机械通气患者89例，在PLR前后采用脉搏指示连续心输出量（pulse indicator continuous cardiac output，PiCCO）监测患者血流动力学变化，经皮氧分压监测装置监测患者PtcO2，采用Pearson法分析PLR后PtcO2变化（△PtcO2）与心指数变化（△CI）的关系，以受试者工作曲线（ROC曲线）分析PtcO2变化在PLR评估容量反应性中的价值，以△CI≥15％为对容量治疗有反应组，否则为无反应组。结果①89例重症患者中，52例有容量反应性（有反应组），37例无容量反应性（无反应组）；有反应组患者PLR后CI及PtcO2较基线值明显增加（P〈0．05），无反应组CI和PtcO2较基线值无变化（P〉0．05）。②△CI与△PtcO2呈正相关r=0．829，P〈0．05）。③△PteO2〉11．5％判断容量反应性的AUC值为0．911，敏感度为84．7％，特异度为90．4％。结论PtcO2变化可以作为PLR评估容量反应性的无创、简单指标。展开更多
Purpose: The aim of this study was to assess the accuracy of a continuous survival probability prediction using noninvasive measures of cardiac performance and tissue perfusion in severely injured pediatric patients. ...Purpose: The aim of this study was to assess the accuracy of a continuous survival probability prediction using noninvasive measures of cardiac performance and tissue perfusion in severely injured pediatric patients. Methods: Review of all patients entered into a prospective noninvasive monitoring protocol. Cardiac index (CI) was measured using a thoracic bioimpedance device and tissue perfusion was assessed by transcutaneous carbon dioxide (PtCO2) tension and oxygen tension indexed to the fraction of inspired oxygen (PtcO2FiO2). Survival probability (SP) was continuously calculated using a stochastic analysis program. Results: There were 45 patients with a total of 953 data sets. The mean age was 11 years (range, 1-16 years) with a mean Injury Severity Score of 24 (±16). There was no difference between survivors (n = 32) and nonsurvivors (n = 13) at study entry for heart rate, blood pressure, CI, or pulse oximetry (all P > .05). However, survivors demonstrated higher PtcCO2 (45 vs 35), higher PtcO2FiO2 (236 vs 156), and higher predicted SP (89%vs 62%) compared with nonsurvivors at study entry and throughout the monitoring period (all P < .01). For the entire data set, the strongest independent predictors of survival were PtcO2FiO2 and SP. The area under the receiver operating characteristic curve for mortality prediction was 0.83 for SP and 0.71 for PtcO2FiO2, compared with 0.6 for heart rate, 0.51 for blood pressure, and 0.53 for CI. Similar hemodynamic patterns were observed for all injury patterns with the exception of those with severe brain injury. Conclusions: Thoracic bioimpedance and transcutaneous monitoring give critical real-time hemodynamic and tissue perfusion data that can provide early identification of pathologic flow patterns and accurately predict survival.展开更多
文摘Purpose: The aim of this study was to assess the accuracy of a continuous survival probability prediction using noninvasive measures of cardiac performance and tissue perfusion in severely injured pediatric patients. Methods: Review of all patients entered into a prospective noninvasive monitoring protocol. Cardiac index (CI) was measured using a thoracic bioimpedance device and tissue perfusion was assessed by transcutaneous carbon dioxide (PtCO2) tension and oxygen tension indexed to the fraction of inspired oxygen (PtcO2FiO2). Survival probability (SP) was continuously calculated using a stochastic analysis program. Results: There were 45 patients with a total of 953 data sets. The mean age was 11 years (range, 1-16 years) with a mean Injury Severity Score of 24 (±16). There was no difference between survivors (n = 32) and nonsurvivors (n = 13) at study entry for heart rate, blood pressure, CI, or pulse oximetry (all P > .05). However, survivors demonstrated higher PtcCO2 (45 vs 35), higher PtcO2FiO2 (236 vs 156), and higher predicted SP (89%vs 62%) compared with nonsurvivors at study entry and throughout the monitoring period (all P < .01). For the entire data set, the strongest independent predictors of survival were PtcO2FiO2 and SP. The area under the receiver operating characteristic curve for mortality prediction was 0.83 for SP and 0.71 for PtcO2FiO2, compared with 0.6 for heart rate, 0.51 for blood pressure, and 0.53 for CI. Similar hemodynamic patterns were observed for all injury patterns with the exception of those with severe brain injury. Conclusions: Thoracic bioimpedance and transcutaneous monitoring give critical real-time hemodynamic and tissue perfusion data that can provide early identification of pathologic flow patterns and accurately predict survival.
