摘要
目的 探讨床旁超声在预测脓毒症休克合并机械通气患者容量反应性中的临床价值。方法 前瞻性纳入2019年1月1日至2020年12月31日我院重症医学科收治的脓毒症休克患者,分别于容量负荷试验前后应用脉搏指示连续心排量监测获得心率、平均动脉压、中心静脉压、心脏指数(CI)、胸腔内血容积指数、每搏量变异度(SVV);应用床旁超声测量颈动脉血流动力学参数,计算下腔静脉内径变异度(ΔIVCd)、颈动脉峰流速变异度(ΔCDPV)、颈动脉血流量及颈动脉血流量变异度(ΔCBF)。将容量负荷试验后CI增加值(ΔCI)≥10%定义为容量反应阳性,根据患者有无容量反应性进行分组,比较两组容量负荷试验前后上述参数的差异;分析各血流动力学参数与ΔCI的相关性;绘制受试者工作特征(ROC)曲线分析各血流动力学参数对脓毒症休克合并机械通气患者容量反应性的预测价值。结果 最终纳入49例患者,其中有容量反应性者26例(有反应性组),无容量反应性者23例(无反应性组)。有反应性组容量负荷试验前SVV、ΔIVCd、ΔCDPV均高于无反应性组,ΔCBF高于无反应性组,差异均有统计学意义(均P<0.05)。相关性分析显示,容量负荷试验前SVV、ΔIVCd、ΔCDPV和ΔCBF均与ΔCI呈正相关(r=0.425、0.856、0.855、0.874,均P<0.05)。ROC曲线分析显示,SVV、ΔIVCd、ΔCDPV、ΔCBF预测脓毒症休克合并机械通气患者容量反应性的曲线下面积分别为0.696、0.713、0.725、0.734。结论 应用床旁超声监测颈动脉血流动力学参数可有效预测无自主呼吸、无心律失常的脓毒症休克合并机械通气患者的容量反应性,有一定的临床价值。
Objective To explore the clinical value of bedside ultrasound in predicting volume responsiveness in patients with septic shock and mechanical ventilation.Methods Septic shock patients admitted to the department of critical care medicine of our hospital from January 1,2019 to December 31,2020 were enrolled.The heart rate,mean arterial pressure,central venous pressure,cardiac index(CI),intrathoracic blood volume index and stroke volume variability(SVV)before and after volume load test were obtained by pluse indicator continous cadiac output.Hemodynamics parameters of the carotid artery were measured by bedside ultrasound,the variability of the inferior vena cava diameter(ΔIVCd),variability of carotid peak flow velocity(ΔCDPV),carotid artery blood flow(CBF)and carotid artery blood flow variability(ΔCBF)were calculated.The increased CI(ΔCI)after the volume load test with a value of≥10%was defined as a positive capacity response,patients were grouped according to whether they had volume response,and the differences of the above parameters between the two groups before and after the volume load test were compared.The correlation between hemodynamics parameters andΔCI was analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of hemodynamics parameters for volume responsiveness in patients with septic shock and mechanical ventilation.Results Finally,49 patients were included,26 cases were responsive to the volume load test(responsive group)and 23 cases were not responsive to the volume load test(non-responsive group).SVV,ΔIVCd andΔCDPV before the volume load test of the responsive group were higher than those of the non-responsive group,and theΔCBF was higher than that of the non-responsive group,the differences were statistically significant(all P<0.05).Correlation analysis showed that SVV,ΔIVCd,ΔCDPV,ΔCBF before the volume load test were all positively correlated withΔCI(r=0.425,0.856,0.855,0.874,all P<0.05).ROC curve analysis showed that the areas under the curve
作者
朱肇基
叶宏伟
汪易岚
俞隼
范佳
沈耀亮
金钧
ZHU Zhaoji;YE Hongwei;WANG Yian;YU Sun;FAN Jia;SHEN Yaoiang;JIN Jun(Department of Critical Care Medicine,Suzhou University Affiliated Changshu Hospital,Jiangsu 215500,China)
出处
《临床超声医学杂志》
CSCD
2024年第1期59-64,共6页
Journal of Clinical Ultrasound in Medicine
基金
常熟市科技局课题项目(CS201919)。
关键词
超声检查
床旁
颈动脉血流动力学
脓毒症休克
机械通气
容量反应性
Ultrasonography,bedside
Carotid hemodynamics
Septic shock
Mechanical ventilation
Volume responsiveness
