被动抬腿试验联合心脏超声心动图预测感染性休克患者容量反应性的价值

摘要

Objective To evaluate the hemodynamic response to passive leg raising (PLR),indicated fluid responsiveness in patient with Septic shock.Method Thrity-two patients with Septic shock who considered for fluid challenge(FC)were enrolled in the study. Hemodynamic changes were determined before and after PLR.return to base line for 10 min,before and after fluid chal-lenge.An increase of SV after fluid challenge≥15%were defined responders.Results Thrity-two patients were included in the study. among which 23 inslancea were defined as response group. SV,CO induced by PLR(PLR-ΔSV and PLR-ΔCI)were in-creased significantly in response group[(53.8 ±5.66)ml vs (46.4 ±4.9)ml,((5.0 ±0.41)ml/min vs (4.4 ±0.25)L/(min),P<0.05],while in nonresponse group there were no significant change.PLR-ΔSV and PLR-ΔCO were correlated with FC-ΔSV (r=0.76,P<0.01;r=0.63,P<0.01). Central venous pressure(CVP)were negative correlated with FC-ΔSV(r=-0.39,P=0.03).Area under curve(AUC)for (PLR-ΔSV and PLR-ΔCO were 0.87 and 0.80).For PLR-ΔSV≥9.4% to evaluate the volume responsiveness,the sensitivity was 95.7%,specificity was 66.7%. For PLR-ΔCO≥9.7%to evaluate the volume respon-fiveness,the sensitivity was 78.3%,specificity was 77.8%. Conclusion PLR-ΔSV ,PLR-ΔCO can predict fluid responsive-ness in patients with Septic shock.%目的：探讨被动抬腿试验（passive leg raising，PLR）联合经胸彩色多普勒预测感染性休克患者容量反应性的价值。方法：选取32例感染性休克患者纳入研究，检测患者有创动脉血压、中心静脉压（centeral venous pressure CVP）、每搏输出量（stroke volume SV）、心输出量（cardiac output CO）等血流动力学后指标，进行被动抬腿试验，在进行被动抬腿试验后再行补液试验，利用超声心动图监测PLR及补液试验前后血流动力学的变化。以补液试验后每搏量（SV）增加值（ΔSV）≥15％为容量反应组，SV增加值（ΔSV）＜15％为容量无反应组。评价PLR前后SV 的变化（ΔSV）、CO的变化（ΔCO）及CVP变化（ΔCVP）预测容量反应性的价值。结果：32例患者行PLR和补液试验，其中有反应组23例，无反应组9例。反应组PLR后SV明显增加[（53.8±5.6）ml比（46.4±4.9）ml，P＝0.045]；PLR后CO增加（5.0±0.41）L／（min）比（4.4±0.25）L／（min）。无反应组PLR后CVP较前明显增加[（14.8±3.5）cm H2O比（12.8±3.6）cm H2O，P＝0.005）]。PLR后SV变化率、CO变化率与补液试验后SV变化率呈正相关（r＝0.76，P＜0.01；r＝0.63，P＜0.01），中心静脉压（CVP）与补液试验后ΔSV负相关（r＝－0.39，P＝0.03）。PLR－ΔSV、PLR－ΔCI 预测容量反应性的ROC 曲线下面积分别为0.87、0.80以PLR－ΔSV≥9.4％评价容量反应性，灵敏度为95.7％，特异度为66.7％；PLR－ΔCO≥9.7％评价反应性；灵敏度分别为78.3％和77.8％。结论：通过被动抬腿时间及超声心动图测定出PLR－ΔSV、PLR－ΔCO可用于评估感染性休克患者的容量反应性，可作指导液体治疗参考。