小剂量容量负荷试验对脓毒症患者液体反应性的预测价值

发布时间：2018-01-20 19:19

本文关键词： 小剂量容量负荷试验脓毒症心排血量液体反应性预测　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评估小剂量容量负荷试验预测脓毒症患者液体反应性的预测价值,为脓毒症患者的合理扩容治疗提供一定的临床参考和理论依据。方法:选择2015年8月至2017年1月于我院急诊科就诊,入院后诊断为脓毒症需行呼吸机辅助通气的患者22例为研究对象。对所有患者给予常规治疗后,予锁骨下静脉穿刺置管和股动脉穿刺PICCO置管,实施PICCO监测。小剂量容量负荷前测量HR、MAP、CVP、CO、PPV、SVV、EVLWI为T0,经中心静脉导管在1分钟内快速输注100ml 0.9%氯化钠溶液后再次测量上述指标为T1,测量结束30分钟后继续在30分钟内输注500ml 0.9%氯化钠溶液,再次测量上述指标为T2,每个指标连续测量3次后取平均值。以T2-T0所测CO增加10%定义为容量有反应性,根据对液体反应性分为阳性组和阴性组,以T1-T0所测CO的增加率为△CO。所有患者均测量T0、T1、T2三个时间点血管外肺水指数,并统计分析T2和T1同T0比较其结果是否有统计学意义。△CO、PPV和CVP的其敏感性与特异性用受试者操作特性曲线(ROC曲线)进行分析。结果:1根据对液体反应性分组后,阳性组12例和阴性组10例,阳性组与阴性组相比,各组患者的一般临床资料相比无统计学差异(P0.05)。2小剂量容量负荷试验的△CO在ROC曲线下面积为0.85(95%CI:0.695-1.005),最佳敏感性为0.85,特异性为0.70,最佳预测截点为△CO=0.15。3小剂量容量负荷试验中EVLWI在T1期与T0及T2相比结果无统计学意义,T2与T0相比T2的EVLWI明显升高,结果有统计学意义(P=0.0001)。4容量反应指标△CO、PPV、CVP预测液体反应性经ROC曲线下面积比较△CO的预测敏感性及特异性最佳。结论:1小剂量容量负荷试验在脓毒症患者中应用较为安全,△CO可以作为小剂量容量负荷试验液体反应性的预测指标,最佳敏感性为0.85,特异性为0.70。2△CO、PPV对脓毒症患者液体反应性的预测较CVP敏感。
[Abstract]:Objective: to evaluate the predictive value of low-dose volume-load test in predicting fluid reactivity in septic patients. To provide a certain clinical reference and theoretical basis for the rational treatment of sepsis. Methods: from August 2015 to January 2017 in our emergency department. Twenty-two patients who were diagnosed as sepsis who needed ventilator assisted ventilation were studied. After routine treatment, subclavian vein puncture and femoral artery PICCO catheter insertion were performed in all patients. PICCO monitoring was carried out. Before low dose capacity loading, HRT MAPP, CVP, PICCO, VV and EVLWI were measured to be T0. After fast infusion of 100ml 0.9% sodium chloride solution through the central venous catheter within one minute, the above indexes were measured again as T1. After 30 minutes of measurement, 500 ml 0.9% sodium chloride solution was infused within 30 minutes, and the above indexes were measured again as T2. The average value of each index was taken after 3 consecutive measurements. The volume reactivity was defined as the increase of CO in T2-T0, which was divided into positive group and negative group according to the reactivity of liquid. The increase rate of CO measured by T1-T0 was CO. All patients were measured the extravascular pulmonary water index at T _ 0 T _ 1 T _ 2. Statistical analysis of T _ 2 and T _ 1 compared with T _ 0 results were statistically significant. Co. The sensitivity and specificity of PPV and CVP were analyzed by using the operating characteristic curve (ROC curve). Results 12 cases of positive group and 10 cases of negative group were divided into positive group and negative group according to their reactivity to liquid. The positive group was compared with the negative group. There was no significant difference in general clinical data among the three groups. The area of CO under the ROC curve was 0.85 (P0.05n.2). 95 CI: 0.695-1.005). The best sensitivity was 0.85 and the specificity was 0.70. The best predicted cut-off point was that there was no significant difference between EVLWI and T _ 0 and T _ 2 in T1 phase of CO=0.15.3 low-dose load test. Compared with T0, the EVLWI of T2 was significantly higher than that of T0, and the results were statistically significant. The sensitivity and specificity of CVP in predicting fluid reactivity were best compared with CO under the ROC curve. Conclusion it is safe to use the small dose volume load test of 1: 1 in sepsis patients. Co can be used as a predictor of liquid reactivity in low-dose volume-loading test. The optimum sensitivity is 0.85 and the specificity is 0.70.2 CO. PPV is more sensitive than CVP in predicting fluid reactivity in septic patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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