PICCO和超声评估脓毒性休克容量反应性的研究

发布时间：2018-06-06 20:05

  本文选题：每博量变异 + 下腔静脉直径　； 参考：《郑州大学》2017年硕士论文

【摘要】：背景和目的脓毒性休克,脓毒症的一种亚型,指脓毒症患者虽然经过足量的液体复苏后,低血压仍持续存在,需要用血管活性药物维持平均动脉压大于65mmHg,血清乳酸水平大于2 mmol/L(18 mg/dL)。脓毒性休克是影响人类的主要健康问题,每年全球新增数百万患者,大约四分之一或更多的患者出现死亡,与多发性创伤、急性心肌梗塞或中风类似;脓毒症发生后及时采取合适的治疗方案,极可能影响患者的预后。通过对比脉波指示剂连续心排血量法(pulse indicator continuous cardiac output,PICCO)监测每博量变异度(SVV)和床旁彩色多普勒超声监测下腔静脉直径(IVCD)及呼吸变异指数(RVI)评估脓毒性休克患者的容量反应性,以监测指导脓毒性休克患者的液体复苏。方法采用前瞻性队列对40例控制性机械通气脓毒性休克患者行PICCO监测,记录补液前后心排血量(CO)、心排指数(CI)、心率(HR)、每搏输出量变异率(SVV)、平均动脉压(MAP),并应用床旁超声记录补液前后呼气末下腔静脉最大直径(IVCDmax)及吸气末下腔静脉最小直径(IVCD min),以公式RVI=(IVCDmax-IVCDmin)/IVCDmax×100%计算下腔静脉RVI;20min内给予500ml复方氯化钠溶液快速静脉输注,将补液后△CI≥15%定义为容量有反应组,△CI15%定义为容量无反应组。比较补液前后2组血流动力学参数、SVV、RVI的变化,评估补液后有容量反应性组SVV与RVI,SVV、RVI分别与△CI的相关性,并以受试者工作特征曲线(ROC曲线)分析SVV、RVI的敏感度和特异度。结果40例患者中,24例为容量有反应,16例为容量无反应。补液后SVV、RVI均与△CI呈正相关,SVV和RVI亦存在相关(r=0.859,P0.01),ROCsvv、ROCrvi曲线下面积分别为0.841±0.061、0.858±0.057,统计学无差异,95%可信区间分别为0.721~0.961和0.746~0.971。SVV对预测容量反应性的诊断阈值为11%(敏感度为83.6%,特异度为81.4%),RVI诊断阈值为26%(敏感度为87.1%,特异度为83.8%)。结论SVV与RVI均能有效评估机械通气脓毒性休克的容量反应性,且具有很好的相关性,均能监测指导上述患者的液体复苏。
[Abstract]:Background and objective septic shock, a subtype of sepsis, refers to the persistence of hypotension in patients with sepsis after adequate fluid resuscitation. Vasoactive drugs were required to maintain mean arterial pressure over 65mmHg and serum lactate levels greater than 2 mmol / L ~ (18) mg / d ~ (-1). Septic shock is a major health problem affecting humans, with millions of new patients worldwide each year, with about 1/4 or more dying, similar to multiple trauma, acute myocardial infarction or stroke; Timely treatment of sepsis may affect the prognosis of patients. The volume reactivity of septic shock patients was evaluated by comparing pulse indicator continuous cardiac output PICCO-pulse indicator continuous cardiac output with pulse indicator continuous cardiac output PICCO-pulse indicator continuous cardiac output (PICCO), inferior vena cava diameter (IVCDD) and respiratory variation index (RVI) monitored by color Doppler echocardiography (CDI) in patients with septic shock. Monitor and guide fluid resuscitation in septic shock patients. Methods 40 patients with septic shock undergoing controlled mechanical ventilation were monitored by PICCO in a prospective cohort. Before and after resuscitation, the cardiac output volume, cardiac output index, heart rate and HRV were recorded. The rate of variation per stroke output was estimated to be SVV, and the mean arterial pressure MAPP was measured by bedside ultrasound. The maximum diameter of IVCDmax. of inferior vena cava before and after infusion was recorded by bedside ultrasound) and the minimum straightness of inferior vena cava at the end of inspiratory period was recorded. The 500ml compound sodium chloride solution was given by the formula RVIX / IVCDminmax 脳 100% in 20 minutes. CI 鈮，

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