全心舒张末期容量指数及脉压变异预测感染性休克继发ALI容量反应性

GEDVI and PPV predict fluid responsiveness in patients with ALI secondary to septic shock

目的研究PICCO（脉波指示剂连续心输出量监测）技术预测感染性休克继发ALI（急性肺损伤）患者容量反应性的价值。方法前瞻性观察性研究2010年1月至2012年2月江苏省苏北人民医院重症医学科（ICU）收治的感染性休克继发ALI患者42例，入ICU1h、6h，24h分别进行容量负荷试验。根据容量负荷试验前后SVI增加值是否大于15％分为有反应组和无反应组，比较容量负荷试验有反应者和无反应者间CVP（中心静脉压），SVV（每搏量变异），PPV（脉压变异），GEDVI（全心舒张末期容量指数）及ITBI（胸腔内血容量指数）的差异，通过受试者工作特征（ROC）曲线确定CVP，SVV，PPV，GEDVI及ITBI判断容量反应性的阈值。结果（1）入ICU1h以GEDVI〈643．5mL／m^2及PPV〉13．5％评价感染性休克继发ALI患者容量反应性，灵敏度为90．9％，特异度为91．9％％（P〈0．01）。（2）人ICU6h以GEDVI〈559．0mL／m^2评价感染性休克继发ALI患者容量反应性，灵敏度为100％，特异度为62．5％（P〈0．01）。入ICU24hCVP，SVV，PPV，GEDVI及ITBI对容量均无反应性（P〉0．05）。结论GEDVI及PPV可作为评价感染性休克继发ALI患者早期容量反应性指标。

Objective To evaluate PICCO （pulse indicator continuous cardiac output） to predict fluid responsiveness in patients with acute lung injury secondary to septic shock. Methods We conducted a prospective study on 42 patients with acute lung injury secondary to septic shock, global end-diastolic volume index （GEDVI）, pulse pressure variation （PPV）, stroke volume variation （SVV） , central vein pressure （CVP） and other haemodynamic data were recorded before and after fluid administration of 500 mL of 6% hydroxyethyl starch. Responders were defined as patients with an increase in stroke volume index of at least 15% after fluid loading. Performance of variables was analyzed using receiver operator characteristics analysis. Results GEDVI and PPV, but not SVV and CVP, were able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 1 hrs after admission to intensive care unit （ICU）. The best area under the ROC curve （AUC） was found for GEDVI （ AUC 0. 802, P 〈 0.01 ） and PPV （ AUC 0. 752, P 〈0. 01 ） ; the optimal cut-off of GEDVI and PPV were 643.5 mL/m2 and 13.5%, respectively. At this cut point, the sensitivity was 90. 9%, the specificity was 91.9%, however, only GEDVI was able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 6hrs after admission to ICU. The best area under the ROC curve （AUC） was found for GEDVI （ AUC 0. 788, P 〈 0. 01 ） . the GEDVI 〈 559 mL/m2 during loading were found to predict volume responsiveness with a sensitivity of 100%, specificity of 62. 5%. Conclusions GEDVI and PPV predict flui.d responsiveness in patients with acute lung injury secondary to septic shock in the early hours.