中心静脉压动态变化预测感染性休克患者容量反应性的临床观察

Clinical observation of central venous pressure dynamic change in prediction of capacity response in patients with septic shock

目的观察中心静脉压动态变化(△CVP)与外周动脉压心排量监测(APCO)在感染性休克患者容量评估中的相关性。方法本研究采用前瞻性、观察性、队列研究的设计方法,选择2012年2月-2014年8月在医院重症医学科的感染性休克患者纳入研究。所有患者进行晶体液500ml 30min内静脉滴入,并用飞利浦监护仪进行补液前后中心静脉压测量,计算△CVP;用APCO持续监测扩容前后各项血流动力学指标变化,根据对扩容的反应(扩容后SV增加15%为有反应)将患者分为有反应组和无反应组,观察△CVP与APCO的相关性。评估△CVP在预测感染性休克患者容量反应中的临床价值。结果共有39例感染性休克患者纳入本研究,扩容后有反应者占58.9%(23/39),反应组△CVP为(1.6±0.9)mm Hg(P<0.05),无反应组△CVP为(4.2±1.6)mm Hg(P<0.05),△CVP与△SV呈显著负相关性(r=0.654 P=0.038)。结论中心静脉压的动态变化是容量评估中的较好指标,可用来指导临床液体治疗。

Objective To investigated the correlation between central venous pressure（ △CVP） dynamic change and arterial pressure waveform analysis of cardiac output（ APCO） in the capacity assessment of patients with septic shock. Methods The study was performed with prospective,cohort study method,and patients with septic shock who were admitted to the intensive care unit of the people hospital of Xing Tang county from February 2012 to August 2014 were enrolled. All patients were given compound sodium chloride 500ml（ 30 minutes of intravenous drip infusion）,and to measure central venous pressure before and after rehydration with philips monitor,then calculate △CVP. APCO continued to detect the changes in hemodynamics before and after expansion. According to the expansion of the reaction（ that the SV added 15% was deemed to have reaction after expansion）,the patients were divided into reaction group and non reaction group. The correlation was observed between△CVP and APCO. To assess the clinical value of △CVP in the prevention of capacity reaction in patients with septic shock.Results Among 39 cases of patients included in this study,23 patients were responders（ accounted for58. 9%）. The△CVP was1. 6 ± 0. 9mm Hg in reaction group（ P〈0. 05）. The △CVP was 4. 2 ± 1. 6mm Hg in non reaction group（ P〈0. 05）. △CVP showed a significant negative correlation with△SV（ r = 0. 654,P = 0. 038）. Conclusion Danamic changes of central venous pressure is a better indicator of capacity assessment,which can be used to guide the clinical treatment of liquid.