摘要
目的探讨左室流出道(LVOT)血流速率时间积分(VTI)在预测非老年感染性休克患者容量反应性的应用价值。方法选取2018年1月~10月海南医学院第二附属医院重症监护病房(ICU)收治的70例非老年感染性休克患者,进行容量负荷试验,并根据液体反应情况分为有反应组(39例)与无反应组(31例),测定LVOT血流VTI、每搏量(SV)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)及心输出量(CO)等血流动力学指标的变化,并采用受试者工作特征(ROC)曲线分析VTILVOT预测感染性休克容量反应性的价值。结果有反应组负荷试验后HR降低,MAP、CVP上升,MAP高于无反应组,HR、CVP低于无反应组,差异有统计学意义(P<0.05);两组负荷试验后SV、CO均上升(P<0.05),但组间比较差异无统计学意义(P>0.05)。有反应组负荷试验后VTILVOT升高,与同组负荷试验前及无反应组负荷试验后比较,差异均有统计学意义(P<0.05),有反应组△SV高于无反应组,差异有统计学意义(P<0.05)。VTILVOT与△SV呈正相关(r=0.797,P<0.05);△SV预测感染性休克容量反应性曲线下面积(AUC)为0.848,△SV为11.73%时预测敏感度、特异性分别为90.87%、78.23%;VTILVOT预测感染性休克AUC为0.869,VTILVOT为15.50%预测敏感度、特异性分别为92.00%、86.42%。结论VTILVOT预测感染性休克患者容量反应性敏感度、特异性均较高,可作为指导其补液治疗的依据。
Objective To explore the application value of left ventricular outflow tract(LVOT)velocity time integral(VTI)in predicting fluid responsiveness in non-elderly patients with septic shock.Methods 70 non-elderly patients with septic shock admitted to intensive care unit(ICU)of Second Affiliated Hospital of Hainan Medical College from January 2018 to October 2018 were enrolled in the study.The volumetric load test was performed,and the patients were divided into responsive group and non-responsive group according to the fluid responsiveness.Changes of hemodynamic parameters such as LVOT velocity time integral(VTI),stroke volume(SV),heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP)and cardiac output(CO)were measured,and the receiver operating characteristic curve(ROC)was used to analyze the value of VTILVOTin predicting fluid responsiveness of septic shock.Results After load test,the HR in responsive group was decreased while the MAP and CVP were increased,and the MAP was higher than that in non-responsive group while the HR and CVP were lower than those in non-responsive group(P<0.05).The SV and CO after load test were increased in the two groups(P<0.05),but there were no significant differences between the groups(P>0.05),and the VIVLVOTafter load test in responsive group was increased,and there was a significant difference compared with that before load test and that in non-responsive group after load test(P<0.05),and the△SV in responsive group was higher than that in non-responsive group(P<0.05).VTILVOTwas positively correlated with△SV(P<0.05).The area under the curve(AUC)of△SV was 0.848 in predicting fluid responsiveness of septic shock,and the predicted sensitivity and specificity were 90.87%and78.23%respectively whenΔSV was 11.73%.The AUC of VTILVOTwas 0.869 in predicting fluid responsiveness of septic shock,and the predicted sensitivity and specificity were 92.00%and 86.42%respectively when VTILVOTwas 15.50%.Conclusion VTILVOThas high sensitivity and specificity in predicting fluid
作者
王金忠
吴忠勇
周德兴
王小智
Wang Jinzhong;Wu Zhongyong;Zhou Dexing(Department of Critical Care Medicine,The Second Affiliated Hospital of Hainan Medical University,Haikou 570311,China)
出处
《中华保健医学杂志》
2020年第2期124-127,共4页
Chinese Journal of Health Care and Medicine
基金
2018年海南省自然科学基金(818MS150)。
