每搏量变异度监测指导感染性休克术中容量治疗的应用价值

Value of stroke volume variation monitoring in guiding volume therapy during infectious shock

目的探讨通过每搏量变异度（SVV）监测指导感染性休克术中容量治疗的临床应用价值。方法将28例感染性休克患者分人SVV组（13例）和中心静脉压（CVP）组（15例）。SVV组患者根据SVV的动态变化指导静脉补液速度，当sVV〉13％时，行快速静脉补液；SVV≤13%时限制静脉补液；维持SVV≤13％。两组患者维持有创动脉血压（ABP）水平≥65mmHg（1mmHg=0．133kPa），不能维持时静脉输注去甲肾上腺素。CVP组患者根据CVP的动态变化指导补液速度，CVP％8cmH2O（1cmH2O=0．098kPa）时，行快速静脉补液，CVP为8～12cmH。O时限制静脉补液。记录两组患者的术中晶体液快速输注量、胶体液快速输注量、晶体液维持量、晶体液输注总量、胶体液输注总量、去甲肾上腺素用量，手术前后的血流动力学和容量监测指标，以及水肿发生情况。结果SVV组术中晶体液快速输注量、胶体液快速输注量、晶体液维持量、晶体液输注总量、胶体液输注总量、总输液量均显著少于CVP组（P值均〈O．05）。与同组术前比较，两组术后心率均显著减慢（P％0．05），平均动脉压、心脏指数、CVP均显著升高（P值均〈O．05）；SVV组术后SVV显著高于CVP组同时间（P〈0．05），术后CVP显著低于CVP组同时间（P〈0．05）。SVV组术中去甲肾上腺素用量为（41．9±8．0）μg，显著高于CVP组的（25．9±5．2）μg（P〈0．01）。SVV组水肿发生率为2／13，显著低于CVP组的8／15（P〈0．05）。结论SVV能准确、可靠地评估患者的容量状态，对指导感染性休克术中容量治疗具有重要价值。

Objective To investigate the value of stroke volume variation （SVV） monitoring in guiding volume therapy during infectious shock. Methods A total of 28 patients with infectious shock were divided into SVV group （n= 13） and central venous pressure （CVP） group （n = 5）. Patients in the SVV group were given volume therapy according to the SVV： when SVV〉 13%, rapid fluid replacement; when SVV≤ 13%, fluid replacement was limited to maintain the situation. The arterial blood pressure （ABP） was maintained ≥65 mmHg （1 mmHg= 0. 133 kPa）; otherwise norepinephrine was given intravenously. The rapid volumes of crystalloid and colloid fluid, the maintaining and total volumes of crystalloid, total volume of colloid fluid, amount of norepinephrine, hemodynamic parameters before and after operation, and the development of edema were recorded in the two groups. Results The rapid volumes of crystalloid and colloid fluid, the maintaining and total volumes of crystalloid, total volume of colloid fluid, and total amount of fluid infusion in SVV group were significantly less than those in the CVP group （all P〈0.05）. The heart rates were significantly decreased in the two groups after operation （P〈0. 05）, and the mean artery pressure （MAP）, cardiac index （CI）, and CVP values were significantly increased （all P〈0.05）. The SVV value of SVV group was significantly higher and the CVP value was significantly lower than those of the CVP group （P〈0. 05）. The amount of norepinephrine in the SVV group was （41.9± 8.0） μg, which was significantly more than that in the CVP group （[25.9±5.2] μg, P〈O. 01 ）. Two of the 13 patients in the SVV group developed edema, which was significantly less than that of the CVP group （8/15, P〈0.05）. Conclusion SVV can accurately and reliably evaluate the volume status of patients, showing a value for guiding volume therapy for patients with infectious shock.