摘要
目的探讨床旁超声预测重症监护病房(ICU)感染性休克患者容量反应性的临床价值。方法对2015年1月—4月我院ICU收治的42例进行机械通气的感染性休克患者进行补液试验,补液试验前后均采用超声测量获得每搏量(SV)、主动脉峰值流速呼吸变异率(△VpeakAO)、下腔静脉扩张指数(△IVC)以及肱动脉最大速度变异率(△VpeakBA),并记录临床各项指标。根据对补液的反应将患者分为有反应(R)组和无反应(NR)组,比较2组间上述指标的差异,以及△IVC、△VpeakAO、△VpeakBA与△SV的相关性,采用ROC曲线评价补液前△IVC、△VpeakAO以及△VpeakBA预测感染性休克患者的容量反应性的应用价值。结果 42例患者进行补液试验47例次,R组25例次,NR组22例次。补液前,R组的△IVC、△VpeakAO和△VpeakBA均高于NR组;△IVC、△VpeakAO以及△VpeakBA与△SV呈正相关;△IVC、△VpeakAO以及△VpeakBA曲线下面积分别为0.825、0.853、0.866,均有较高的特异度和敏感度。结论床旁超声测定的血流动力学指标能够预测ICU机械通气感染性休克患者液体治疗时的容量反应性,特异度和敏感度较高,可用于指导其液体治疗。
Objective To study the clinical value of bedside ultrasound in predicting the fluid responsiveness in pa-tients with septic shock in intensive care unit（ICU）. Methods Forty- two mechanically ventilated patients with septicshock who admitted to ICU of the Affiliated Hospital of North China University of Science and Technology from January2015 to April 2015 were included in this study. All patients were treated with volume expansion（VE） text. Hemodynamics in-dexes were obtained by ultrasound before and after each test, including stroke volume（SV）, aortic peak blood flow velocityvariation rate of breathing（△VpeakAO）, inferior vena cava expansion index（△IVC） and brachial artery maximum speed vari-ation rate（△VpeakBA）. Clinical data and central venous pressure（CVP） were recorded. Based on the responsiveness of SV,patients were divided into responsive group（R） and non-responsive group（NR）, respectively. The differences of the above in-dexes were compared between two groups. The correlation of △IVC, △VpeakAO, △VpeakBAand △SV was determined. Therole of the hemodynamic index for predicting volume responsiveness was evaluated by receiver operating characteristic ROCcurves. Results A total of 47 VE tests were performed in 42 patients, 25 in R group and 22 in NR group. Before VE test,the hemodynamics indicators of △IVC, △VpeakAOand △VpeakBAwere significantly higher in R group compared with thoseof NR group（P 0.05）. The values of △IVC, △VpeakAOand △VpeakBAwere positively correlated with △SV in two groups.The areas under the ROC curve of the hemodynamics indicators were 0.825, 0.853 and 0.866 for △IVC, △VpeakAOand△VpeakBA, and they all showed high sensitivity and specificity. Conclusion The hemodynamic index measured by bedsideultrasound can predict the volume responsiveness in mechanically ventilated patients with septic shock fluid therapy, andwhich can be used to fluid therapy with a high degree of specific and sensitivity in clinical practice.
出处
《天津医药》
CAS
2016年第4期470-473,共4页
Tianjin Medical Journal
作者简介
李婷（1988-），女，硕士在读，主要从事超声医学研究
通讯作者E-mail：wuxiny-2009@163．com
