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小剂量容量负荷试验联合经胸心脏超声评估感染性休克患者容量反应性的临床价值研究
沈珏,汪沁,刘文生,黄剑,柳开忠
作者单位
沈珏 浙江省肿瘤医院重症医学科 
汪沁  
刘文生  
黄剑  
柳开忠  
摘要:
目的评估小剂量容量负荷试验联合经胸心脏超声预测机械通气的感染性休克患者容量反应性的价值。方法收集37例接受机械通气的感染性休克患者的临床资料。采用经胸心脏超声技术测定患者在基础状态、1min快速输注100ml晶体液及15min快速输注500ml晶体液后血流动力学变化。以500ml晶体液输注后心输出量(CO)增加值(△CO500)≥15%为容量有反应组,否则为无反应组。分析100ml补液试验后CO变化(△CO100)和主动脉速度时间积分(VTI)变化(△VTI100)的ROC曲线,以此评价小剂量晶体液容量负荷试验效果。结果容量有反应组21例,无反应组16例。所有患者△CO100与△CO500、△VTI100与△CO500均呈正相关(r=0.954、0.726,均P<0.01)。△CO100和△VTI100预测容量反应性的ROC曲线下面积分别为0.961和0.929,以△CO100≥8%评价容量反应性,灵敏度为95.2%,特异度为87.5%,以△VTI100≥10%评价容量反应性,灵敏度为85.7%,特异度为93.8%。结论应用经胸心脏超声测定由1min快速输注100ml晶体液所引起的CO和VTI变化(△CO100和△VTI100)能较准确地预测感染性休克患者的容量反应性,可作为指导容量治疗的指标。
关键词:  容量负荷试验 主动脉速度时间积分 容量反应性 感染性休克 心输出量
DOI:10.12056/j.issn.1006-2785.2017.39.15.2017-1222
分类号:
基金项目:浙江省医药卫生科研项目(2016147603kxxbg)
Low-volume fluid challenge with transthoracic echocardiography in predicting volume responsiveness of septic shock patients
SHEN Jue,WANG Qin,LIU Wensheng,HUANG Jian,LIU Kaizhong
Abstract:
Objective To evaluate the predictive value of low-volume fluid challenge with transthoracic echocardiography for volume responsiveness in mechanically ventilated patients with septic shock. Methods Clinical data of 37 mechanically ventilated patients with septic shock were analyzed prospectively. Hemodynamic parameters were determined by transthoracic echocardiography before fluid challenge (FC), after a 100ml infusion of crystalloid solution over 1 min and a further 400 ml infusion over 15 min. Patients were classified as responders if cardiac output (CO) increased by at least 15% following the 500ml FC and non-responders if CO increased by less than 15%. Receiver operating characteristic curves (ROC curves) were generated for variations of CO and aortic velocity time index (VTI) after infusion of 100 ml of fluid over 1min (ΔCO100 and ΔVTI100). Results Among 37 patients there were 21 responders and 16 non-responders. In all patients, there were positive correlations between ΔCO100 and ΔCO500 (r=0.954, P<0.01), ΔVTI100 and ΔCO500 (r=0.762, P<0.01), respectively. The area under ROC curve (AUC) for ΔCO100 was 0.961 (95% CI: 0.907-1.015). Taking ΔCO100 ≥8% as the cut-off value for predicting fluid responsiveness, the sensitivity and specificity were 95.2% and 87.5%, respectively. The AUC for ΔVTI100 was 0.929 (95% CI: 0.848-1.009). Taking ΔVTI100 ≥10% as cut-off value for predicting fluid responsiveness, the sensitivity and specificity were 85.7% and 93.8%, respectively. Conclusion ΔCO100 and △VTI100 measured by transthoracic echocardiography can predict the fluid responsiveness in septic shock patients and it can be used for guiding fluid therapy.
Key words:  Fluid challenge Aortic velocity time index Fluid responsiveness Septic shock Cardiac output