摘要
目的探讨每搏连续无创血压监测系统(CNAP)结合被动抬腿试验(PLR)对脓毒性休克患者容量反应性的预测价值。方法前瞻性观察福建省立医院重症医学四科2019年7月-2020年7月收治的脓毒性休克患者36例,置入锁骨下静脉导管后,先进行PLR,再行容量负荷试验(VE)。研究过程采用CNAP监测,每个试验前后均监测心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排量(CO)及脉压变异度(PPV),记录PLR前后CO的变化率(ΔCO_(PLR))及VE前后CO的变化率(ΔCO_(VE))。将ΔCO_(VE)≥15%定义为有容量反应性并纳入有反应组,ΔCO_(VE)<15%者纳入无反应组。采用Pearson检验分析ΔCO_(PLR)、VE前PPV与ΔCO_(VE)的相关性;采用受试者工作特征(ROC)曲线评估ΔCO_(PLR)、VE前PPV对容量反应性的预测价值。结果36例脓毒性休克患者共进行40例次VE,其中有反应组18例次,无反应组22例次。两组患者PLR及VE前的血流动力学指标差异均无统计学意义(P>0.05)。两组患者PLR及VE后HR、MAP均无明显变化(P>0.05);两组PLR后CVP无明显变化(P>0.05),VE后CVP均明显增加(P<0.05),但组间差异无统计学意义(P>0.05)。两组患者PLR及VE后CO均明显增加(P<0.05),有反应组PLR及VE后CO明显高于无反应组[(6.01±1.28)L/min vs.(5.16±1.22)L/min、(6.31±1.33)L/min vs.(5.15±1.39)L/min,P<0.05]。有反应组ΔCO_(PLR)、ΔCO_(VE)明显高于无反应组(21.21%±8.54%vs.10.76%±4.94%、26.32%±8.64%vs.9.44%±3.45%,P<0.05)。ΔCO_(PLR)与ΔCO_(VE)呈正相关(r=0.820,P<0.05),而VE前PPV与ΔCO_(VE)无相关性(r=0.194,P>0.05)。ΔCO_(PLR)预测脓毒性休克患者容量反应性的曲线下面积(AUC)为0.855(95%CI 0.707~0.946,P<0.05),最佳截断值为13.95%,敏感度为83.3%,特异度为81.8%;VE前PPV预测容量反应性的AUC仅为0.525(95%CI 0.362~0.685,P>0.05)。结论CNAP监测ΔCO_(PLR)可用于预测脓毒性休克患者的容量反应性,指导临床液体治疗。
Objective To investigate the predictive value of continuous non-invasive arterial pressure monitor(CNAP)combined with passive leg raising(PLR)test for volume responsiveness assessment in patients with septic shock.Methods Prospective and observational study was performed in the patients with septic shock admitted to the Fourth Department of Intensive Care Unit(ICU)of Fujian Provincial Hospital from July 2019 to July 2020.Subclavian venous catheter was indwelled in each patient,then the hemodynamic parameters including heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac output(CO)and pulse pressure variability(PPV)were measured non-invasively by CNAP before and after PLR and volume expansion(VE)test.The changes of CO during PLR test(ΔCO_(PLR))and VE test(ΔCO_(VE))were calculated respectively.Patients were classified as responder group or non-responder group according to theΔCO_(VE) increased≥15%or not after VE test.Moreover,Pearson's test was used for the correlation analysis.The roles ofΔCO_(PLR) and PPV before VE test in predicting volume responsiveness were evaluated by receiver operating characteristic(ROC)curve.Results A total of 40 VE tests in these 36 patients were evaluated and resulting in 18 responder group and 22 non-responder group.There was no significant difference between two groups in the hemodynamics parameters before PLR and VE test(P>0.05).Both in responder group and non-responder group,there was no significant change in HR and MAP after PLR and VE test(P>0.05).After PLR,CVP did not change significantly in the two groups(P>0.05).CVP after VE test increased significantly in the two groups(P<0.05),but there was no significant difference between the two groups(P>0.05).CO was obviously increased after PLR and VE test in the two groups(P<0.05).In responder group,CO after PLR and VE test were significantly higher than those in non-responder group[(6.01±1.28)L/min vs.(5.16±1.22)L/min,(6.31±1.33)L/min vs.(5.15±1.39)L/min,P<0.05].Besides,theΔCO_(PLR) andΔCO_(VE) in
作者
薛贻敏
陈美琪
黄廷烽
陈明光
陈茜
陈锋
Xue Yi-Min;Chen Mei-Qi;Huang Ting-Feng;Chen Ming-Guang;Chen Qian;Chen Feng(Provincial Clinical Medical College of Fujian Medical University,Fuzhou 350001,China;The Fourth Department of Intensive Care Unit,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Emergency/Fujian Provincial Key Laboratory of Emergency Medicine,Fujian Provincial Hospital,Fuzhou 350001,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2021年第11期1112-1117,共6页
Medical Journal of Chinese People's Liberation Army
基金
福建省重症医学中心建设项目(2017-510)。
关键词
每搏连续无创血压监测系统
被动抬腿试验
脓毒症
容量反应性
continuous non-invasive arterial pressure monitor
passive leg raising
sepsis
volume responsiveness
