摘要
目的探讨容量负荷试验(扩容试验)前后有效动脉弹性(Ea)对感染性休克患者容量反应性的判断价值。方法采用回顾性研究方法,选择2016年10月至2020年10月北京协和医院内科重症监护病房(MICU)收治的116例感染性休克患者作为研究对象。所有患者接受血流动力学监测,给予500 mL琥珀酰明胶或平衡盐溶液进行容量负荷试验。收集扩容前10 min和扩容后即刻心率(HR)、平均动脉压(MAP)、心排血量(CO)等血流动力学指标。扩容后即刻CO升高>10%定义为容量有反应性;同理,MAP升高>10%定义为血压有反应性。绘制受试者工作特征曲线(ROC曲线),分析扩容前Ea等动脉负荷指标对容量反应性和血压反应性的判断价值;采用Pearson相关性分析评价基线Ea与CO、MAP变化率的相关性。再将容量有反应组按照血压反应性分为血压有反应组和血压无反应组,探讨Ea和动脉负荷在循环复苏中的临床意义。结果 116例患者中63例表现为容量有反应性,53例为无反应性。容量有无反应性两组患者扩容前一般情况及各项生理指标比较差异均无统计学意义。容量有反应组患者扩容前Ea明显高于容量无反应组(mmHg/mL:2.51±1.08比1.87±0.68,P<0.01)。ROC曲线分析显示,扩容前基线Ea能预测容量反应性,其ROC曲线下面积(AUC)=0.71,95%可信区间(95%CI)为0.62~0.81,P<0.001,当阈值定为1.97 mmHg/mL时,其敏感度为71.4%,特异度为60.4%;但基线Ea无法判断容量负荷试验中血压反应性(AUC=0.52,95%CI为0.41~0.63,P=0.73)。Pearson相关性分析显示,基线Ea与扩容后CO变化率有良好的正相关性(r=0.47,P<0.001),但与扩容后MAP变化率则呈弱正相关性(r=0.20,P=0.03)。在63例容量有反应性患者中,27例(42.9%)血压有反应性,36例(57.1%)血压无反应性。血压有无反应性两组患者扩容前基线Ea及血流动力学指标比较差异均无统计学意义。扩容后血压无反应组和血压有反应组Ea均较扩容前降�
Objective To explore the validity of the effective arterial elastance(Ea)before and after fluid challenge in evaluating the fluid challenge in septic shock patients.Methods A retrospective study was conducted in the medical intensive care unit(MICU)of Peking Union Medical College Hospital from October 2016 to October 2020.116 septic shock patients were enrolled.All patients received fluid challenge by 500 mL Gelatin or normal saline under invasive hemodynamic monitoring.Heart rate(HR),mean arterial pressure(MAP),cardiac output(CO)and other hemodynamic variables were collected at 10 minutes before and immediately after fluid challenge.An increase in CO greater than 10%after fluid challenge was defined as the positive preload responsiveness,as well as the definition of positive pressure responsiveness was an increase in MAP greater than 10%.Receiver operating characteristic curves(ROC curves)were established to evaluate the predictive abilities of baseline Ea and other arterial load indices in detecting the preload responders and pressure responders.The correlation of the baseline Ea with CO changes after fluid challenge as well as MAP changes were tested by Pearson correlation analysis.Patients with positive preload responsiveness were divided into two groups according to the pressure responsiveness.The changes in Ea and other arterial load indices were analyzed.Results A total of 116 patients were finally analyzed.Sixty-three patients were preload responders and 53 patients were preload non-responders.There was no significant difference in demographics and baseline physical variables between the two groups.Ea in preload responders was higher than that in preload non-responders(mmHg/mL:2.51±1.08 vs.1.87±0.68,P<0.01).ROC curve analysis showed that the baseline Ea could predict the preload responsiveness at an area under ROC curve(AUC)=0.71[95%confidence interval(95%CI)was 0.62-0.81,P<0.001].The cut-off value was 1.97 mmHg/mL with a sensitivity of 71.4%and a specificity of 60.4%.The baseline Ea did not present the
作者
杨婷
黄惠斌
翁利
杜斌
Yang Ting;Huang Huibin;Weng Li;Du Bin(Department of Medical Intensive Care Unit,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Critical Care Medicine,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2021年第3期269-275,共7页
Chinese Critical Care Medicine
基金
国家重点研发计划项目(2020YFC0841300)
北京市科技计划课题(Z201100005520037)。
关键词
有效动脉弹性
动脉负荷
感染性休克
容量反应性
Effective arterial elastance
Arterial load
Septic shock
Fluid responsiveness
