Objective To explore the predictive value of low volume volume expansion(Low-VE)and pulse contour-derived cardiac index(PiCCO)on fluid responsiveness in elderly patients with septic shock. Methods A prospective observational cohort study was conducted. Forty-six elderly pa-tients suffering from septic shock admitted to Department of Intensive Care Unit of our hospital from May 2014 to April 2015 were enrolled. The patients were studied in three phases:before test, Low-VE(100 mL saline infused with 1 minute), and volume expansion(VE)with infusing of 250 mL saline within 10 minutes. Hemodynamic parameters were recorded in every phase. Responders and nonresponders were de-fined by stroke volume(SV)variation after VE. A positive response was defined as a≥15%increase in SV(ΔSVVE≥15%). The receiver operating characteristic(ROC)curve was used to predict the value of hemodynamic parameters before and after Low-VE. Results Of 46 patients, 16 patients were responders, and 30 non-responders. The changes in SV and cardiac output(CO)after Low-VE(ΔSVLow-VE andΔCOLow-VE)were significantly higher in responders than those of non-responders[ΔSVLow-VE:(11.0 ± 3.5)%vs.(4.6 ± 2.7)%, t=6.882 , P=0.000;ΔCOLow-VE:(9.7 ± 4.5)%vs.(4.1 ± 3.2)%, t=4.857, P=0.000], but there was no significant difference in the changes in systolic blood pressure(SBP), mean arterial pressure (MAP), pulse pressure (PP), and heart rate (HR) after Low-VE (ΔSBPLow - VE,ΔMAPLow-VE, ΔPPLow-VE and ΔHRLow-VE)between two groups. The area under ROC curve(AUC)ofΔSVLow-VE≥8.1% for predicting fluid responsiveness was(0.928 ± 0.042, P=0.000), with sensitivity of 81.2% and specificity of 93.3%; the AUC of ΔCOLow-VE≥6.3% for predicting fluid responsiveness was (0.858 ± 0.057, P=0.000), with sensitivity of 87.5%and specificity of 73.3%. Conclusion In elderly patients with septic shock, changes in SV and CO induced by Low-VE are accurate indices for pre-dicting fluid responsiveness, but the changes in SBP, MAP, PP, HR and stroke volume variation(SVV) cannot predict the fluid responsiveness.%目的 探讨小剂量容量负荷试验(Low-VE)联合脉搏轮廓分析技术(PiCCO)对老年感染性休克患者容量反应性的预测价值.方法 采用前瞻性观察性队列研究方法,选择2014-05~2016-04本院重症医学科收治的46例老年感染性休克患者.分别于试验前、Low-VE后(1 min内输注100 mL生理盐水)、容量负荷试验(VE)后(10 min内输注250 mL生理盐水)三个阶段记录血流动力学指标,根据VE后每搏量变化值(ΔSVVE)将患者分为液体复苏有反应组(ΔSVVE≥15%)和液体复苏无反应组(ΔSVVE<15%).绘制受试者工作特征(ROC)曲线,分析各血流动力学指标预测容量反应性的敏感度及特异度.结果 46例患者中16例为有反应组,30例为无反应组.有反应组Low-VE后引起的SV变化值(ΔSV Low-VE)及心排血量(CO)变化值(ΔCO Low-VE)较无反应组明显升高[ΔSV Low-VE:(11.0±3.5)%比(4.6±2.7)%,t=6.882,P=0.000;ΔCO Low-VE:(9.7±4.5)%比(4.1±3.2)%,t=4.857,P=0.000],而Low-VE引起的收缩压(SBP)、平均动脉压(MAP)、脉搏压(PP)、心率(HR)的变化值(ΔSBP Low-VE、ΔMAP Low-VE、ΔPP Low-VE、ΔHR Low-VE)在两组间比较差异无统计学意义.以ΔSV Low-VE≥8.1%预测患者容量反应性的ROC曲线下面积(AUC)为0.928±0.042(P=0.000),敏感度为81.2%,特异度为93.3%;以ΔCO Low-VE≥6.3%预测患者容量反应性的AUC为0.858±0.057(P=0.000),敏感度为87.5%,特异度为73.3%.结论 在老年感染性休克患者中,Low-VE引起的SV及CO变化值能准确预测容量反应性,而其引起的SBP、MAP、PP、HR的变化值及每搏量变异率(SVV)均不能有效预测容量反应性.
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