摘要
目的探讨感染性休克患者股动脉平均动脉压(MAPF)变化率、桡动脉平均动脉压(MAPR)变化率、中心静脉压(CVP)变化率评估容量反应性的临床价值。方法选择2012年11月至2014年7月收入福建省立医院重症外科的52例感染性休克并需要实施容量复苏的患者,进行脉搏指示连续心输出量监测(PiCCO)、左侧桡动脉动脉压、CVP监测,在早期15min内快速静脉滴注500mL生理盐水进行容量复苏。记录容量复苏前后MAPF、MAPR、CVP、心搏量指数(SVI),以容量复苏后SVI变化率是否≥15%分为有反应组和无反应组,并行统计学分析。结果入选患者中容量复苏有反应组28例,其容量复苏后MAPF、MAPR和CVP均有提高[MAPF:(74.4±7.7)比(65.0±6.8)mm Hg;MAPR:(69.9±10.4)比(58.6±9.1)mm Hg;CVP:(11.8±2.6)比(9.4±2.2)mm Hg,均P<0.01]。而容量复苏无反应组24例,其容量复苏后MAPF、MAPR和CVP变化无统计学意义[MAPF:(71.8±8.0)比(70.8±8.6)mm Hg;MAPR:(67.6±10.7)比(65.1±11.3)mm Hg;CVP:(11.9±4.0)比(10.6±3.4)mm Hg,均P>0.05]。容量复苏前后MAPF和MAPR的变化率(ΔMAPF和ΔMAPR)分别与SVI变化率(ΔSVI)呈正相关(ΔMAPF:r=0.530,P<0.001;ΔMAPR:r=0.427,P=0.002),受试者工作特征(ROC)曲线显示判断容量复苏有反应的最佳截断值分别为ΔMAPF≥9.7%(敏感性为75.0%,特异性为79.2%)和ΔMAPR≥13.9%(敏感性为67.9%,特异性为70.8%);两者ROC曲线下面积分别为0.822和0.757。容量复苏前后CVP变化率(ΔCVP)与ΔSVI无明显相关性(r=0.057,P=0.689),其ROC曲线下面积为0.644。结论ΔMAPF和ΔMAPR可作为评估感染性休克患者容量反应性的指标,其中ΔMAPF评估液体反应性更为准确。ΔCVP不能作为评估感染性休克患者容量反应性的指标。
Objective To investigate the predictive value of the change rates of femoral and radial mean arterial pressures before and after fluid challenge for volume responsiveness in patients with early septic shock. Methods Fifty-two patients diagnosed with septic shock and needed volume resuscitation in the Department of Surgical Intensive Care Unit were enrolled between November 2012 and July 2014. All patients were monitored with pulse indicator continuous cardiac output（PiCCO）,left radial artery pressure and central venous pressure（CVP）and injected500 mL normal saline in the first 15 minutes. Femoral mean arterial pressure（MAPF）,radial mean arterial pressure（MAPR）,CVP and stroke volume index（SVI）were recorded before and after fluid challenge. The 28 patients with the SVI≥15% were assigned into response group and others into non-response group.Results The MAPF,MAPRand CVP significantly increased in the response group[（74.4±7.7）vs（65.0±6.8）mm Hg,（69.9±10.4）vs（58.6±9.1）mm Hg and（11.8±2.6）vs（9.4±2.2）mm Hg,respectively,P〈0.01 for all]. While in non-response group,MAPF,MAPR and CVP did not show significant change [（71.8±8.0）vs（70.8±8.6）mm Hg,（67.6±10.7）vs（65.1±11.3）mm Hg,（11.9±4.0）vs（10.6±3.4）mm Hg,respectively;P〉0.05 for all].ΔMAPF（r=0.530,P〈0.001）andΔMAPR（r=0.427,P=0.002）were positively correlated with that of SVI as reflected by Pearson correlation analysis. In receiver operating characteristic curve analysis,ΔMAPF≥9.7% was regarded as an optimal cutoff with sensitivity of 75.0%,specificity of 79.2%,the area under curve of 0.822,andΔMAPR≥13.9% was regarded as an optimal cutoff with sensitivity of 67.9%,specificity of 70.8%,the area under curve of 0.757. ΔCVP was not correlated withΔSVI（r=0.057,P=0.689）,with the corresponding area under curve of 0.644. Conclusion BothΔMAPFandΔMAPRcan be used to predict volume responsiveness in early septic shock,whileΔCVP can’t. Compared toΔMAPR,ΔMAPFis more accurate in pr
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2014年第11期1057-1060,共4页
Chinese Journal of Hypertension
基金
国家重点学科(重症医学)建设项目资助[2011(170)]
关键词
平均动脉压变化率
中心静脉压变化率
感染性休克
容量反应
Changing rate of mean arterial pressure
Changing rate of central venous pressure
Septic shock
Fluid responsiveness
