每搏量变异对顽固性感染性休克患者容量反应性的临床评估分析

Clinical value analysis of stroke volume variation in assessing volume responsiveness of refractory septic shock patients

目的探讨每搏量变异(SVV)对顽固性感染性休克患者容量反应性的评估作用,指导顽固感染性休克患者的临床治疗。方法选取医院2013年1月-2014年12月30例感染性休克患者作为研究对象,对其进行容量负荷试验,并依据每搏量指数(SVI)进行分组,即反应组18例与无反应组12例,对两组试验前后的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)以及心脏指数(CI)、SVI、SVV和全心舒张末容积指数(GEDVI)以及胸腔内血容量指数(ITBVI)进行对比观察。结果试验前两组患者HR、MAP、CVP、CI、SVI、GEDVI、ITBVI比较,差异无统计学意义;试验后反应组HR明显降低,CI、SVI、MAP、CVP、GEDVI、ITBVI明显升高;试验后无反应组GEDVI、ITBVI明显升高,而HR、MAP、CVP、CI、SVI无明显变化,且两组间HR、CI、SVI、GEDVI、ITBVI比较,差异有统计学意义(P<0.05);试验前反应组SVV明显的高于无反应组,差异有统计学意义(P<0.05);试验后反应组SVV明显的低于无反应组,差异有统计学意义(P<0.05)。结论临床中应用SVV对顽固性感染性休克患者的容量反应性可以较好的进行评估,且临床中应用价值高。

OBJECTIVE To investigate the value of stroke volume variation（SVV）in assessing the capacity reactivity of refractory septic shock patients,so as to guide clinical treatment of refractory septic shock patients.METHODS Totally 30 cases of septic shock patients were selected as research subjects from Jan.2013 to Dec.2014,capacity load test was carried out.Based on stroke volume index（SVI）,patients were divided into response group（18cases）and non-response group（12cases）.Heart rate（HR）,before and after test,mean arterial pressure（MAP）,central venous pressure（CVP）and cardiac index（CI）,SVI,SVV and dedicated end-diastolic volume index（GEDVI）and intrathoracic blood volume index（ITBVI）were compared between the two groups.RESULTS Before the test,the difference of HR,MAP,CVP,CI,SVI,GEDVI,ITBVI between the two groups was not significant.After the test,the HR in response group decreased significantly,while CI,SVI,MAP,CVP,GEDVI,and ITBVI clearly increased.As for non-respond group,GEDVI and ITBVI significantly increased after the test,while HR,MAP,CVP,CI,SVI had no significant change,and the difference of HR,CI,SVI,GEDVI,ITBVI between the two groups was significant（P〈0.05）.Before the test,SVV in response group was significantly higher than that in non-response group（P〈0.05）.After the test,SVV in response group was significantly lower than that in non-response group,the difference was statistically significant（P 0.05）.CONCLUSION The clinical application of volume responsiveness（SVV）can better assess the capacity reactivity of refractory septic shock patients,and has high clinical application value.