中心静脉压与全心舒张末容积指数预测机械通气的感染性休克患者液体反应性准确性的比较

Comparison of central venous pressure and global end diastolic volume index predicting fluid responsiveness in mechanically ventilated patients with septic shock

目的比较中心静脉压(central venous pressure,CVP)与全心舒张末容积指数(global end diastolic volume index,GEDVI)预测机械通气的感染性休克患者液体反应性的准确性。方法 55例机械通气的感染性休克患者进行55次液体负荷试验,经静脉以6 mL/kg 30 min输注6%羟乙基淀粉200/0.5,经右颈内静脉或锁骨下静脉监测CVP,采用脉搏指示连续心输出量(pulse-induced contour cardiac output,PiCCO)监测液体负荷前后心脏指数(cardiac index,CI)、GEDVI,将CI增加值(△CI)≥15%定义为液体反应阳性。观察液体负荷试验前后血流动力学的变化,评价CVP、GEDVI与△CI的相关性。结果容量治疗有反应者治疗后CVP变化率高于容量治疗无反应者,但差异无统计学意义(P>0.05);容量治疗有反应者治疗后GEDVI变化率高于容量治疗无反应者,差异有统计学意义(P<0.01)。容量治疗后CVP及GEDVI与治疗前之差为增量,发现△CVP与△CI无明显相关性,而/△GEDVI与△CI呈正相关(r=0.816,P<0.01)。结论与CVP相比,GEDVI能够更好地反映感染性休克患者心脏前负荷,能够预测液体反应性。

Objective To assess fluid responsiveness in mechanically ventilated patients with septic shock by central venous pressure（CVP）and global end diastolic volume index（GEDVI）. Methods Fifty-five mechanically ventilated patients with septic shock underwent 55 liquid load tests（LLT）,within 30 minutes,the subjects received an intravenous infusion of 6 ml/kg of 6%hydroxyethyl starch（200/0.5）.The CVP was monitored through a catheter introduced via the right internal jugular vein and the subclavian vein.The cardiac index（CI）and GEDVI before and after fluid loading were monitored by pulse-induced contour cardiac output（PiCCO）.Positive fluid responsiveness was defined as an increase in CI（△CI）by 15% or more.Hemodynamic changes before and after LLT were observed and the correlations between CVP,GEDVI and △CI were assessed.Results The change rate of CVP after volume treatment of responders was higher than that of non-responders,but there was no significant difference （P 〉 0.05 ）.The change rate of GEDVI after volume treatment of responders was higher than that of non-responders,there was significant difference（P 〈0.01）.CVP and GEDVI before the resuscitation showed increase after the resuscitation.There was no significant correlation between △CVP and △CI,while there was positive correlation between △GEDVI and △CI（r =0.816,P 〈0.01）.Conclusion Compared with＆nbsp;CVP,GEDVI can better reflect cardiac preload in septic shock patients,and predict fluid responsiveness.