液体反应性对急性呼吸窘迫综合征的预后价值

Prognostic value of fluid responsiveness in acute respiratory stress syndrome

目的探讨液体反应性对急性呼吸窘迫综合征（ARDS）患者的预后价值。方法本前瞻性临床研究在浙江中医药大学附属第二医院ICU进行。59例在接受机械通气的ARDS患者，采用脉搏波指示连续心排血量（PiCCO）技术测定其每搏输出量变异（SVV），根据SVV值将患者分为液体有反应组（SVV≥15％）和液体无反应组（SVV〈15％）；比较两组患者28d生存率、ICU住院时间、机械通气时间的差异；Kaplan-Meier法分析患者累积生存情况；采用Logistic回归分析SVV与患者28d生存率的关系。结果与液体无反应组比较，液体有反应组患者28d生存率明显增高（85．3％vs．56．0％，P=0．012），ICU住院时间明显减少[（（13．1±5．2）dVS．（21．6±9．0）d，P=0．008）、机械通气时间明显缩短[（11．4±5．3）dVS．（18．3±4．9）d，P=0．022]；Logistic回归分析显示：SVV〈15％显著增高ARDS患者28d死亡风险（OR=4．82；95％CI：2．67～11．71，P=0．009）。结论以SVV为基础的液体反应性可以作为ARDS患者的预后指标。

Objective To investigate the prognostic value of fluid responsiveness in patients with acute respiratory stress syndrome （ARDS）. Methods Fifty-nine mechanically ventilated patients with ARDS were enrolled. Their stroke volume variations （SVV） were detected by pulse contour continuous cardiac output （PiCCO） analysis device, and then the patients were subsequently divided into fluid responsive group （SVV〉15%） and fluid non-responsive group （ SVV 〈 15% ）. The differences in 28-day survival, length of ICU stay and duration of mechanical ventilation between the 2 groups were compared. Thereafter, the 28-day survival of patients was analyzed by Kaplain-Meier survival model and the relationship between SVV and mortality within 28 days was analyzed by logistic regression model. Results In comparison with fluid non-responsive group, the 28-day survival of fluid responsive group was significantly increased （85.3% vs. 56.0%, P =0. 012）, the length of ICU stay was significantly shortened [ （ 13.1± 5.2 ） d vs. （21.6±9. 0） d, P = 0. 008 ], and the duration of mechanical ventilation was significantly shortened as well [ （ 11.4 ± 5.3） d vs. （ 18.3 ± 4. 9） d, P = 0. 022 ] ; Logistic analysis revealed that SVV 〈 15% increased the risk of 28-day mortality （ OR = 4. 82; 95% CI： 2. 67 ±11.71, P = 0. 009）. Conclusions SVV-based fluid responsiveness can be served as a prognostic predictor for ventilated patients with ARDS.