中心静脉压联合被动抬腿试验在感染性休克病人容量反应评估中的作用

赵波; 李鹏; 郭启芬; 李佳

doi:10.13898/j.cnki.issn.1000-2200.2022.12.009

中心静脉压联合被动抬腿试验在感染性休克病人容量反应评估中的作用

Role of central venous pressure combined with passive leg raising in the assessment of volume responsiveness in patients with septic shock

摘要

摘要:
目的探讨中心静脉压（CVP）联合被动抬腿试验（PLR）在感染性休克病人容量反应评估中的作用。
方法选取感染性休克病人110例作为研究对象，均使用脉搏指数连续心输出量（PiCCO）持续监测病人CVP、平均动脉压（MAP）、每搏输出量（SV）、每搏量变异度（SVV）、心输出量（CO）、心指数（CI）及心率（HR），并接受PLR和容量负荷试验，将PLR试验后CVP、SV、SVV、CI变化率，记录为△CVP、△SV、△SVV、△CI；将容量负荷试验后SV增幅（△SV容量负荷试验）≥10%作为阳性组，△SV容量负荷试验 < 10%作为阴性组。使用Pearson检验分析感染性休克病人△CVP与△SV、△SVV、△CI的相关性，并采用ROC曲线分析△CVP、△SV、△SVV、△CI对感染性休克病人容量反应性的预测价值。
结果110例病人共进行192次PLR和容量负荷试验，其中阳性组88例次（45.83%），阴性组104例次（54.17%）。PLR后2组病人CVP、SV、CI均高于基础值，且阳性组病人高于阴性组病人，2组病人SVV均低于基础值，且阳性组病人低于阴性组病人，差异均有统计学意义（P < 0.05）。感染性休克病人△CVP与△SV和△CI呈正相关关系（P < 0.05），与△SVV呈负相关关系（P < 0.05）。△CVP、△SV、△SVV、△CI联合预测感染性休克病人容量反应性的曲线下面积为0.963，高于四者单独预测，其预测敏感度85.60%，特异度98.90%。
结论△CVP、△SV、△SVV、△CI联合使用，对感染性休克病人容量反应性的预测效果最好。

Abstract:
ObjectiveTo investigate the role of central venous pressure(CVP) combined with passive leg raising(PLR) in the assessment of volume responsiveness in patients with septic shock.
MethodsOne hundred and ten patients with septic shock who were enrolled were selected as the research objects.The CVP, mean arterial pressure(MAP), stroke volume(SV), stroke volume variation(SVV), cardiac output(CO), cardiac index(CI) and heart rate(HR) were continuously monitored by pulse index continuous cardiac output(PiCCO), and PLR and volume load test were carried out.The change rates of CVP, SV, SVV and CI after PLR test were recorded as △CVP, △SV, △SVV, and △CI.The SV increment(△SV volume load test) ≥ 10% was regarded as positive group after volume load test, △SV volume load test < 10% was taken as negative group.Pearson test was used to analyze the correlation between △CVP and △SV, △SVV, △CI in patients with septic shock, and the ROC curve was used to analyze the predictive values of △CVP, △SV, △SVV, △CI on the volume responsiveness of patients with septic shock.
ResultsA total of 192 PLR and volume load test were carried out in 110 patients, including 88 cases in the positive group(45.83%) and 104 cases in the negative group(54.17%).After PLR test, CVP, SV and CI in the two groups were higher than the basic value, and those in the positive group were higher than the negative group; the SVV of the two groups was lower than the basic value, and that in the positive group was lower than the negative group, the difference was statistically significant(P < 0.05).△CVP of patients with septic shock was positively correlated with △SV and △CI(P < 0.05), negatively correlated with △SVV(P < 0.05).The area under the curve of the combination of △CVP, △SV, △SVV and △CI in predicting the volume response of patients with septic shock was 0.963, which was higher than that predicted by the four alone, the predictive sensitivity was 85.60%, and the specificity was 98.90%.
ConclusionsThe combination of △CVP, △SV, △SVV, △CI has the best prediction effect on the volume responsiveness of patients with septic shock.

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