摘要
目的:探讨每搏输出量变异度对老年脓毒症休克患者容量反应性的预测价值。方法:回顾性收集安徽医科大学第三附属医院重症监护室(ICU)2015-10-2017-02期间32例行机械通气的脓毒症休克老年患者为研究对象,对其进行容量负荷试验,以每搏量指数(SVI)作为容量反应性指标,△SVI≥10%为反应组,△SVI<10%为无反应组,采用FloTrac/Vigileo监护系统监测心输出量(CO),中心静脉血氧饱和度(ScvO2),外周血管阻力指数(SVRI),每搏输出量(SV),每搏输出量变异度(SVV)等血流动力学相关指标,研究SVV对容量反应性的预测价值,并通过绘制受试者的工作特征(ROC)曲线,来分析SVV预测容量反应性的灵敏度和特异度。结果:32例患者中,20例为容量反应阳性,12例为容量反应阴性;两组患者容量负荷试验前HR,MAP,CVP,CO,ScvO2,SVRI,SV等血流动力学指标的比较,差异无统计学意义,而反应组的SVV明显高于无反应组,差异有统计学意义;与试验前比较,两组患者试验后的HR明显下降,MAP、CVP、CO、ScvO2、SVRI、SV明显升高,且试验后反应组的HR,MAP,CVP,CO,ScvO2,SVRI,SV与无反应组这些指标之间的比较,差异均有统计学意义;试验后反应组SVV较之前明显下降,且与无反应组相比较,差异都是有统计学意义的;SVV预测容量反应性的ROC曲线分析结果示,曲线下面积(AUC)为0.875(95%置信区间(CI):0.801~0.972),以SVV≥12%预测容量反应性,灵敏度为0.891,特异度为0.900。结论:SVV可更好的预测老年脓毒症休克患者的容量反应性,具有较高的临床应用价值。
Objective：To investigate the predictive value of SVV in fluid responsiveness of elderly patients with septic shock. Method： Retrospectively collected 32 elderly patients with septic shock of the ICU of the Third Affiliated Hospital of Anhui Medical University from October 2015 to February 2017. Volume-loading test was performed,and stroke volume index （SVI） was served as an indicator estimating volume responsiveness. The patients with SVI increased value more than or equal to 10% were served as reaction group,and the patients with SVI increased value less than 10 % were served as non-reaction group. Cardiac output （CO） ,Central venous blood oxygen saturation （ScvO2）, Systemic vascular resistance index （SVRI）, Stroke volume （SV）, Stroke volume variation （SVV） and other related parameters of hemodynamics were measured by Flotrac/Vigileo. Study the predictive value of SVV in fluid responsiveness, the sensitivity and specificity of predictive fluid responsiveness of SVV were an- alysed by receiver operating characteristic （ROC） Cure. Result： Out of 32 patients, 20 were positive volume reaction,and 12 were negative volume reaction. There were no statistical difference in HR, MAP, CVP, CO, ScvO2, SVRI,SV before volume-loading test between two groups,but before the test, SVV in reaction group was significantly higher than that in non-reaction group, so there was statistical difference in SVV. And after the test, the HR in two groups decreased significantly, while MAP, CVP, CO, ScvO2, SVRI, SV clearly increased, and there were statistical difference in HR, MAP, CVP,CO, ScvO2, SVRI, SV of two groups. And after the test, SVV in reaction group was significantly lower than before, and compared with that in non-reaction group, there was also statistical difference in SVV. The area under the Roc cure （Auc） for stroke volume variation （SVV） was 0. 875, （95%CI： 0. 801 %0. 972）. Using SVV≥12 %as the threshold to predict fluid responsiveness, the sensitivity was 89.1 % and specific
出处
《临床急诊杂志》
CAS
2017年第10期783-786,共4页
Journal of Clinical Emergency
基金
合肥市科技局科研计划项目(No:合科[2008]23号)
