被动抬腿试验对感染性休克患者的容量反应性评价

发布时间：2018-04-03 19:56

  本文选题：感染性休克　切入点：被动抬腿试验　出处：《上海医学》2016年10期

【摘要】：目的探讨被动抬腿(PLR)试验对进行早期液体复苏的感染性休克患者的容量反应性评价。方法选取51例感染性休克患者进行PLR试验和液体复苏,根据液体复苏结果将患者分为有反应组[扩容后每搏输出量(SV)较PLR前增加≥15%,27例]和无反应组(扩容后SV较PLR前增加15%,24例)。在PLR前、PLR时、扩容前和扩容后各时间点,监测患者的SV、心输出量(CO)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)等血流动力学指标的变化。根据PLR试验后SV对患者补液的容量反应性绘制ROC曲线,计算其AUC,并分析其相关性。结果有反应组PLR时和扩容后的SV、CO、CVP均显著大于同组PLR前(P值分别0.01、0.05),组内各时间点间HR、MAP的差异均无统计学意义(P值均0.05);无反应组组内各时间点间SV、CO、HR、MAP、CVP的差异均无统计学意义(P值均0.05)。有反应组PLR时、扩容前和扩容后的SV分别较同组PLR前增加(12.1±6.6)、(8.3±5.1)和(20.8±4.7)mL,无反应组PLR时、扩容前和扩容后的SV分别较同组PLR前增加(4.7±5.4)、(-0.4±3.3)和(4.1±2.8)mL,有反应组PLR时、扩容前和扩容后SV的改变值均显著大于无反应组(P值均0.01)。PLR试验后SV对患者补液容量反应性的ROC曲线的AUC为0.756(P=0.009);患者PLR试验后SV越小,其补液容量反应性越好,且SV为47.5 mL时尤登指数最大(为0.560)。结论 PLR试验可有效评估进行早期液体复苏的感染性休克患者的容量反应性。
[Abstract]:Objective to evaluate the volumetric reactivity of septic shock patients undergoing early fluid resuscitation by passive leg lift PLR test.Methods 51 patients with septic shock were selected for PLR test and fluid resuscitation.According to the results of fluid resuscitation, the patients were divided into two groups: the response group (27 cases with SVV after dilatation) and the non-response group (24 cases with SVV increased by 15% compared with those before PLR after enlargement) and non-response group (n = 24).The changes of hemodynamic parameters such as PLR, cardiac output, heart rate, mean arterial pressure, central venous pressure and so on were monitored at different time points before and after PLR.According to the volume response of SV to rehydration after PLR test, the ROC curve was drawn, and the correlation was analyzed.缁撴灉鏈夊弽搴旂粍PLR鏃跺拰鎵╁�瑰悗鐨凷V,CO,CVP鍧囨樉钁楀ぇ浜庡悓缁凱LR鍓，

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