呼吸末阻断试验评估感染性休克机械通气患者血容量的临床价值研究

Clinical value of end-expiratory blocking test in assessment of blood volume of septic shock patients undergoing mechanical ventilation

目的研究呼气末阻断试验(EEO)在感染性休克机械通气患者容量反应性中的预测效果,以提高容量反应性评估方法、指导患者血容量复苏。方法选取2013年9月-2015年9月医院重症医学科收治的160例感染性休克机械通气患者临床资料进行分析,采用随机对照方法将患者分为对照组和试验组,每组各80例,对照组为对容量负荷试验无反应性,试验组为对容量负荷试验有反应性,患者入院后对其进行EEO,分析其在感染性休克机械通气患者容量反应性中的预测效果。结果两组患者不同基线下EEO和被动抬腿试验对心率、收缩压、平均血压、舒张压差异无统计学意义;试验组基线1脉压和心脏指数下EEO水平显著高于对照组(P<0.05);试验组基线2脉压和心脏指数水平下PLR显著高于对照组(P<0.05)。结论感染性休克机械通气患者采用EEO、心脏指数以及脉压等指标均能评估患者容量反应性,而EEO评估容量反应性更加可靠。

OBJECTIVE To study the effect of end-expiratory blocking test on prediction of volume responsiveness of the septic shock patients undergoing mechanical ventilation so as to improve the assessment of volume responsiveness and provide guidance for recovery of blood volume.METHODS The clinical data were collected from 160 septic shock patients who underwent the mechanical ventilation in the critical care medicine department from Sep2013 to Sep 2015,then the enrolled patients were randomly divided into the control group and the experimental group,with 80 cases in each.The control group was not responsive to the capacity load test,while the experimental group was responsive to the capacity load test,the end-expiratory blocking test was carried out for the patients after the admission to the hospital,and the effect of the end-expiratory blocking test on prediction of volume responsiveness of the septic shock patients undergoing mechanical ventilation was observed.RESULTS There was no significant difference in the heart rate,systolic pressure,average blood pressure,or diastolic pressure under different baselines of end-expiratory blocking test and passive leg raising test between the two groups of patients.The levels of end-expiratory blocking test under cardiac index and baseline 1pulse pressure were significantly higher in the experimental group than those in the control group（P〈0.05）;the levels of end-expiratory blocking test under cardiac index and baseline 2pulse pressure were significantly higher in the experimental group than those in the control group（P〈0.05）.CONCLUSION The indicators such as the end-expiratory blocking test,cardiac index,and pulse pressure can be used for assessment of the volume responsiveness of the septic shock patients undergoing mechanical ventilation,and the end-expiratory blocking test is more reliable.