动态动脉弹性对休克患者扩容后血压反应的预测价值

Value of dynamic arterial elastance in the predication of arterial pressure response to volume loadingin shock patients

目的探讨具有容量反应性的休克患者中，动态动脉弹性（Eadyn）对快速扩容后血压反应性的预测价值。方法回顾性分析2011年1月至2012年12月收住北京协和医院ICU符合入选条件的患者32例。患者都因休克需快速扩容治疗。根据快速扩容后MAP的变化，患者分为平均动脉压（MAP）有反应组（MAP增加≥15％）和MAP无反应组（MAP增加〈15％）。评价两组快速扩容后MAP变化的影响因素、Eadyn对快速扩容后MAP有反应的预测价值。结果基线Eadyn是有效预测快速扩容后MAP变化的因素。预测快速扩容后MAP有反应的ROC曲线下面积0．95（P〈0．01），基线Eadyn〉0．85的预测灵敏度89．5％，特异度92．3％。结论Eadyn对具有容量反应性的休克患者快速扩容后血压反应性有良好的预测价值。

Objective To explore the value of dynamic arterial elastance （Eadyn） in the predication of arterial pressure response to volume loading in shock patients. Methods A total of 32 patients with pulse indicator continuous cardiac output （ PICCO ） monitoring at our intensive care unit from January 2011 to December 2012 were retrospectively studied. The decision of fluid replacement was based upon the presence of shock （ mean arterial pressure （MAP） ≤ 65 mm Hg, systolic arterial pressure 〈 90 ram Hg or a decrease of 40 mm Hg from baseline） and preserved volume responsiveness condition with a stroke volume variation （SVV） value ≥ 10%. According to the MAP increase after volume loading, they were classified into MAP responders （ ≥ 15% ） and MAP nonresponders （ 〈 15% ） respectively. The goal was to investigate the influencing factors of the changes of MAP after volume loading and predict the arterial pressure response to volume loading. Results Significantly different between MAP responders and MAP nonresponders, baseline Eadyn was an effective predictor of MAP increase after volume loading. The area under the ROC curve was 0. 95 for the prediction of volume loading on MAP for Eadyn at baseline （ P 〈 0. 01）. A baseline Eadyn value 〉 0. 85 predicted a MAP increase after volume administration with a sensitivity of 89. 5% and a specificity of 92. 3%. Conclusion Baseline Eadyn may predict accurately arterial pressure response in MAP to volume loading in shock oatients.