超声预测感染性休克患者容量反应性的临床研究

Clinical Investigation of Ultrasound Prediction for Fluid Responsiveness in Patients With Septic Shock

目的 :探讨超声在预测重症监护病房(ICU)感染性休克患者容量反应性中的临床应用价值。方法 :对2015-01至2015-04我院ICU收治的42例进行机械通气的感染性休克患者进行容量负荷试验,试验前后均采用超声测量下腔静脉呼吸变异率(ΔIVC)、主动脉峰值流速呼吸变异率(ΔVpeak_(AO))、肱动脉最大速度变异率(ΔVpeak_(BA))以及每搏量增加值(ΔSV),并记录临床各项指标。根据对试验的反应将患者分为有反应组和无反应组,比较两组上述指标的差异及各参数与ΔSV的相关性,用受试者工作特征曲线(ROC曲线)评价试验前各项指标预测容量反应性的临床价值。结果 :42例患者进行容量负荷试验47次,有反应组25例次,无反应组22例次。试验前,有反应组ΔIVC、ΔVpeak_(AO)以及ΔVpeak_(BA)的值均高于无反应组;ΔIVC、ΔVpeak_(AO)以及ΔVpeak_(BA)与ΔSV显著相关(r分别为0.631、0.668、0.619);ΔIVC、ΔVpeak_(AO)以及ΔVpeak_(BA)曲线下面积分别为0.817、0.853、0.866,且均有较高的特异度和敏感度。结论 :应用超声测定的血流动力学参数能够对ICU机械通气感染性休克患者液体治疗时的容量反应性进行预测,指导其液体治疗。

Objective： To investigate the ultrasound evaluation on fluid responsiveness in patients with septic shock.Methods： There 42 septic shock patients treated by mechanical ventilation in our hospital from 2015-01 to 2015-04 were studied. All patients received volume expansion（VE） text,ultrasound examination was conducted to measure hemodynamic parameters of inferior vena cava variation rate of breathing（ΔIVC）,aortic peak blood flow velocity variation rate of breathing（ΔVpeak_（AO））,brachial artery maximum speed variation rate（ΔVpeak_（BA）） and stroke volume（ΔSV） at before and after text. Based on the response to VE text,the patients were divided into 2 groups as Responsive group and Non-responsive group,the above indexes and their correlations to ΔSV were analyzed. The clinical values of those parameters for predicting volume responsiveness were evaluated by ROC curves.Results： A total of 47 VE tests were conducted in 42 patients including 25 cases in Responsive group and 22 cases in Non-responsive group. Before VE test,the parameters of ΔIVC,ΔVpeak_（AO） and ΔVpeak_（BA） were higher in Responsive group than Non-responsive group; ΔIVC,ΔVpeak_（AO） and ΔVpeak_（BA） were obviously related to ΔSV（r=0.631,0.668 and 0.619）. The area of ΔIVC,ΔVpeak_（AO） and ΔVpeak_（BA） under ROC curves were 0.817,0.853 and 0.866 respectively,they were all with the high sensitivity and specificity. Conclusion： Ultrasound monitored hemodynamic parameters may predict the volume responsiveness in septic shock patients with mechanical ventilation,it could be used for guiding liquid treatment in relevant patients.