每搏输出量变异度在腹内高压容量反应中的临床价值

Role of stroke volume variation in volume responsiveness in patients with intra-abdominal hypertension

目的 ：评价每搏输出量变异度（SVV）在预测腹内高压（IAH）患者容量反应中的临床价值。方法：回顾分析我院普外重症医学科（SICU）收治的IAH（〉10cm H_2O）患者53例进行容量负荷试验,根据试验后每搏输出量（SV）增加值是否〉15%分为有反应组和无反应组。通过PICCO监测仪监测心率（HR）、中心静脉压（CVP）、心脏指数（CI）、平均动脉压（MAP）、胸腔内血容积指数（ITBI）和SVV,观察患者容量负荷试验前后血液动力学变化。结果：53例患者中30例为容量反应性阳性,23例为容量反应性阴性。两组的性别、年龄、APACHEⅡ评分、呼气末正压通气及氧合指数差异均无统计学意义（P〉0.05）。容量负荷试验前后两组HR、CVP、CI、MAP、ITBI差异均无统计学意义（P〉0.05）,而SVV差异有统计学意义（P〈0.05）。SVV曲线下面积（AUC）为0.92,明显高于HR、CVP、MAP、CI、ITBI（0.23-0.46）。结论：SVV可作为IAH容量反应性指标。

Objective： To evaluate the stroke volume variation （SVV） in predicting the clinical value of intra-abdominal hypertension capacity reactions. Methods： A retrospective analysis of surgical intensive care unit （SlCU） of our hospital intra-abdominal hypertension （IAH〉10 cm H20） was tested in 53 patients before and after volume load test. According to load test, the capacity of the stroke volume （SV） increased value is greater than 15% or not is divided into responders and non-responders. Through the PICCO monitoring PR, CVP,CI, MAP, ITBI, SW to observe the changes of hemodynamics in the patients before and after volume load test. Results： Of the 53 patients, 30 cases with positive reactivity for capacity, 23 cases with negative reaction for capacity.The two groups in gender, age, APACHEII score, PEEP and oxygenation index were not significantly different. Volume load between the two groups before and after the test in patients with PR, CVP, CI, MAP, ITBI difference was not statistically significant, but the difference between the two groups of patients before and after SVV in volume load test was statistically significant（P〈0.05）. Receiver op- era{ing characteristic （ROC） curve： the area under the curve （AUC） of SW was 0.92, significantly higher than that of HR,CVP, MAP,CI,ITBI. （0.23-0.46）. Conclusion： SW can be used as volume responsiveness index in patients with intra-abdominal hypertension.