目的探讨呼气末二氧化碳分压（PETCO2）联合被动抬腿试验（PLR）对心脏术后休克患者容量反应性的评估价值。方法采用前瞻性观察性自身前后配对研究设计方法，选择2014年6月至2015年10月浙江大学医学院附属第一医院重症医学科收治的完全...目的探讨呼气末二氧化碳分压（PETCO2）联合被动抬腿试验（PLR）对心脏术后休克患者容量反应性的评估价值。方法采用前瞻性观察性自身前后配对研究设计方法，选择2014年6月至2015年10月浙江大学医学院附属第一医院重症医学科收治的完全机械控制通气的心脏术后休克患者。分别在PLR及容量负荷试验（VE）前后监测PETCO2，用脉搏指示连续心排血量（PiCCO）监测技术监测每搏量变异度（SVV）、心排血指数（CI）、平均动脉压（MAP）等血流动力学指标。根据扩容后CI增加值（△CI）分为有反应组（△CI≥15％）和无反应组（△CI〈15％）。以受试者工作特征曲线（ROC）分析PLR后PETCO2增加幅度（APETCO2PLR）对容量反应性的评估价值。结果41例患者中有容量反应性21例（有反应组），无容量反应性20例（无反应组）。有反应组患者PLR后CI和PETCO2增加值均明显高于无反应组[△CI：（13．5±4．6）％比（3．6±3．5）％，△PETCO2：（7.4±3．4）％比（2．8±2．5）％，均P〈0．05]。△PET CO2 PLR和SVV基线与△CIPLR均呈正相关（r1=0．50、r2=0．38，均P〈0．05）；APETCO2VE、SVV基线、ACIPLR与△CIVE也均呈正相关（r1=0．58、r2=0．56、r3=0．84，均P〈0．01）。△PETCO2PLR评估容量反应性的ROC曲线下面积（AUC）为0．875±0．054[95％可信区间（95％CI）=0．769。0．981，P〈0．05]，以5．8％为临界值时敏感度为76．2％、特异度为90．0％；△CIPLR评估容量反应性的AUC为0．933±0．036（95％CI=0．862～1．000，P〈0．05），以10．4％为临界值时敏感度为81．0％、特异度为90．0％；SVV甚鳢评估容量反应性的AUC为0．831±0．066（95％CI=0．702～0．960，P〈0．05），以12．5％为临界值时敏感度为85．7％、特异度为75．0％。结论PLR后PETCO2的变化值可以作为预测心脏术后机械通气休克患者容量反应性简便、可靠的无�展开更多
Background Few studies have reported the effect of different volume responsiveness evaluation methods on volume therapy results and prognosis.This study was carried out to investigate the effect of two volume responsi...Background Few studies have reported the effect of different volume responsiveness evaluation methods on volume therapy results and prognosis.This study was carried out to investigate the effect of two volume responsiveness evaluation methods,stroke volume variation （SW） and stroke volume changes before and after passive leg raising （PLR-ASV）,on fluid resuscitation and prognosis in septic shock patients.Methods Septic shock patients admitted to the Department of Critical Care Medicine of Zhejiang Hospital,China,from March 2011 to March 2013,who were under controlled ventilation and without arrhythmia,were studied.Patients were randomly assigned to the SVV group or the PLR-ASV group.The SVV group used the Pulse Indication Continuous Cardiac Output monitoring of SW,and responsiveness was defined as SW-＞12％.The PLR-ASV group used ASV before and after PLR as the indicator,and responsiveness was defined as ASV ＞15％.Six hours after fluid resuscitation,changes in tissue perfusion indicators （lactate,lactate clearance rate,central venous oxygen saturation （SCVO2）,base excess （BE））,organ function indicators （white blood cell count,neutrophil percentage,platelet count,total protein,albumin,alanine aminotransferase,total and direct bilirubin,blood urea nitrogen,serum creatinine,serum creatine kinase,oxygenation index）,fluid balance （6-and 24-hour fluid input） and the use of cardiotonic drugs （dobutamine）,prognostic indicators （the time and rate of achieving early goal-directed therapy （EGDT） standards,duration of mechanical ventilation and intensive care unit stay,and 28-day mortality） were observed.Results Six hours after fluid resuscitation,there were no significant differences in temperature,heart rate,blood pressure,SpO2,organ function indicators,or tissue perfusion indicators between the two groups （P ＞0.06）.The 6-and 24-hour fluid input was slightly less in the SW group than in the PLR-ASV group,but the difference was not statistically significant （P ＞0.05）.T展开更多
In the management of critically ill patients, the assessment of volume responsiveness and the decision to administer a fluid bolus constitute a common dilemma for physicians. Static indices of cardiac preload are poor...In the management of critically ill patients, the assessment of volume responsiveness and the decision to administer a fluid bolus constitute a common dilemma for physicians. Static indices of cardiac preload are poor predictors of volume responsiveness. Passive leg raising （PLR） mimics an endogenous volume expansion （VE） that can be used to predict fluid responsiveness. This study was to assess the changes in stroke volume index （SVI） induced by PLR as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis. This was a prospective study. Thirty-two mechanically ventilated patients with severe sepsis were admitted for VE in ICU of the First Affiliated Hospital, Zhejiang University School of Medicine and Ningbo Medical Treatment Center Lihuili Hospital from May 2010 to December 2011. Patients with non-sinus rhythm or arrhythmia, parturients, and amputation of the lower limbs were excluded. Measurements of SVI were obtained in a semi-recumbent position （baseline） and during PLR by the technique of pulse indicator continuous cardiac output （PiCCO） system prior to VE. Measurements were repeated after VE （500 mL 6% hydroxyethyl starch infusion within 30 minutes） to classify patients as either volume responders or non-responders based on their changes in stroke volume index （ASVI） over 15%. Heart rate （HR）, systolic artery blood pressure （ABPs）, diastolic artery blood pressure （ABPd）, mean arterial blood pressure （ABPm）, mean central venous pressure （CVPm） and cardiac index （CI） were compared between the two groups. The changes ofABPs, ABPm, CVPm, and SVI after PLR and VE were compared with the indices at the baseline. The ROC curve was drawn to evaluate the value of ASVI and the change of CVPm （ACVPm） in predicting volume responsiveness. SPSS 17.0 software was used for statistical analysis. Among the 32 patients, 22 were responders and 10 were non-responders. After PLR among the responders, some hemodynamic variables （inclu展开更多
文摘目的探讨呼气末二氧化碳分压（PETCO2）联合被动抬腿试验（PLR）对心脏术后休克患者容量反应性的评估价值。方法采用前瞻性观察性自身前后配对研究设计方法，选择2014年6月至2015年10月浙江大学医学院附属第一医院重症医学科收治的完全机械控制通气的心脏术后休克患者。分别在PLR及容量负荷试验（VE）前后监测PETCO2，用脉搏指示连续心排血量（PiCCO）监测技术监测每搏量变异度（SVV）、心排血指数（CI）、平均动脉压（MAP）等血流动力学指标。根据扩容后CI增加值（△CI）分为有反应组（△CI≥15％）和无反应组（△CI〈15％）。以受试者工作特征曲线（ROC）分析PLR后PETCO2增加幅度（APETCO2PLR）对容量反应性的评估价值。结果41例患者中有容量反应性21例（有反应组），无容量反应性20例（无反应组）。有反应组患者PLR后CI和PETCO2增加值均明显高于无反应组[△CI：（13．5±4．6）％比（3．6±3．5）％，△PETCO2：（7.4±3．4）％比（2．8±2．5）％，均P〈0．05]。△PET CO2 PLR和SVV基线与△CIPLR均呈正相关（r1=0．50、r2=0．38，均P〈0．05）；APETCO2VE、SVV基线、ACIPLR与△CIVE也均呈正相关（r1=0．58、r2=0．56、r3=0．84，均P〈0．01）。△PETCO2PLR评估容量反应性的ROC曲线下面积（AUC）为0．875±0．054[95％可信区间（95％CI）=0．769。0．981，P〈0．05]，以5．8％为临界值时敏感度为76．2％、特异度为90．0％；△CIPLR评估容量反应性的AUC为0．933±0．036（95％CI=0．862～1．000，P〈0．05），以10．4％为临界值时敏感度为81．0％、特异度为90．0％；SVV甚鳢评估容量反应性的AUC为0．831±0．066（95％CI=0．702～0．960，P〈0．05），以12．5％为临界值时敏感度为85．7％、特异度为75．0％。结论PLR后PETCO2的变化值可以作为预测心脏术后机械通气休克患者容量反应性简便、可靠的无�
文摘Background Few studies have reported the effect of different volume responsiveness evaluation methods on volume therapy results and prognosis.This study was carried out to investigate the effect of two volume responsiveness evaluation methods,stroke volume variation （SW） and stroke volume changes before and after passive leg raising （PLR-ASV）,on fluid resuscitation and prognosis in septic shock patients.Methods Septic shock patients admitted to the Department of Critical Care Medicine of Zhejiang Hospital,China,from March 2011 to March 2013,who were under controlled ventilation and without arrhythmia,were studied.Patients were randomly assigned to the SVV group or the PLR-ASV group.The SVV group used the Pulse Indication Continuous Cardiac Output monitoring of SW,and responsiveness was defined as SW-＞12％.The PLR-ASV group used ASV before and after PLR as the indicator,and responsiveness was defined as ASV ＞15％.Six hours after fluid resuscitation,changes in tissue perfusion indicators （lactate,lactate clearance rate,central venous oxygen saturation （SCVO2）,base excess （BE））,organ function indicators （white blood cell count,neutrophil percentage,platelet count,total protein,albumin,alanine aminotransferase,total and direct bilirubin,blood urea nitrogen,serum creatinine,serum creatine kinase,oxygenation index）,fluid balance （6-and 24-hour fluid input） and the use of cardiotonic drugs （dobutamine）,prognostic indicators （the time and rate of achieving early goal-directed therapy （EGDT） standards,duration of mechanical ventilation and intensive care unit stay,and 28-day mortality） were observed.Results Six hours after fluid resuscitation,there were no significant differences in temperature,heart rate,blood pressure,SpO2,organ function indicators,or tissue perfusion indicators between the two groups （P ＞0.06）.The 6-and 24-hour fluid input was slightly less in the SW group than in the PLR-ASV group,but the difference was not statistically significant （P ＞0.05）.T
文摘In the management of critically ill patients, the assessment of volume responsiveness and the decision to administer a fluid bolus constitute a common dilemma for physicians. Static indices of cardiac preload are poor predictors of volume responsiveness. Passive leg raising （PLR） mimics an endogenous volume expansion （VE） that can be used to predict fluid responsiveness. This study was to assess the changes in stroke volume index （SVI） induced by PLR as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis. This was a prospective study. Thirty-two mechanically ventilated patients with severe sepsis were admitted for VE in ICU of the First Affiliated Hospital, Zhejiang University School of Medicine and Ningbo Medical Treatment Center Lihuili Hospital from May 2010 to December 2011. Patients with non-sinus rhythm or arrhythmia, parturients, and amputation of the lower limbs were excluded. Measurements of SVI were obtained in a semi-recumbent position （baseline） and during PLR by the technique of pulse indicator continuous cardiac output （PiCCO） system prior to VE. Measurements were repeated after VE （500 mL 6% hydroxyethyl starch infusion within 30 minutes） to classify patients as either volume responders or non-responders based on their changes in stroke volume index （ASVI） over 15%. Heart rate （HR）, systolic artery blood pressure （ABPs）, diastolic artery blood pressure （ABPd）, mean arterial blood pressure （ABPm）, mean central venous pressure （CVPm） and cardiac index （CI） were compared between the two groups. The changes ofABPs, ABPm, CVPm, and SVI after PLR and VE were compared with the indices at the baseline. The ROC curve was drawn to evaluate the value of ASVI and the change of CVPm （ACVPm） in predicting volume responsiveness. SPSS 17.0 software was used for statistical analysis. Among the 32 patients, 22 were responders and 10 were non-responders. After PLR among the responders, some hemodynamic variables （inclu
