脉搏灌注变异指数对失血性休克患者液体复苏反应性的预测价值

Predictive Value of Pleth Variability Index on Response of Fluid Resuscitation for Patients with Hemorrhagic Shock

目的探讨脉搏灌注变异指数(PVI)对失血性休克患者液体复苏反应性的预测价值,旨在为液体复苏的监测提供参考。方法选取失血性休克患者160例,随机分为对照组、观察组,每组80例。对照组依据中心静脉压指导液体复苏治疗,观察组采用PVI监测并指导液体复苏治疗。比较两组达到复苏目标的时间、复苏液体正平衡量、平均动脉压(MAP)、6 h中心静脉氧饱和度(Scv O2)、凝血酶原时间(PT),记录患者病死率及并发症发生情况,包括急肾功能衰竭(ARF)、弥漫性血管内凝血(DIC)、急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)及其他并发症。结果对照组液体正平衡量多于观察组、PT长于观察组,差异具有统计学意义(P<0.05);两组达到复苏目标时间、MAP、6h Scv O2比较,差异均无统计学意义(P>0.05)。对照组病死率及合计并发症发生率均高于观察组(P<0.05),但ARF、DIC、ARDS、MODS及其他并发症发生率比较,差异均无统计学意义(P>0.05)。结论 PVI对失血性休克患者液体复苏具有良好的反应性,可灵敏的监测、反映机体循环血容量状态,且液体复苏量小,有利于维护内环境的稳态,患者存活率高、并发症发生率较低,对提高患者的监测、诊疗和预后效果具有较高的临床价值。

Objective To investigate predictive value of pleth variability index（PVI） on response of fluid resuscitation for patients with hemorrhagic in order to provide reference for monitoring fluid resuscitation.Methods A total of160 patients with hemorrhagic shock were randomly divided into group A and B（n = 80 for each group）.Group A was given fluid resuscitation by guidance of central venous pressure,while group B was given fluid resuscitation by guidance of PVI.In two groups,time of achieving resuscitation goal,fluid volume of achieving positive fluid balance,mean arterial pressure（MAP）,central venous oxygen saturation（Scv O2） 6 h after resuscitation and prothrombin time（PT） were compared,and incidence rates of mortality and complications were recorded,which included acute renal failure（ARF）,disseminated intravascular coagulation（DIC）,acute respiratory distress syndrome（ARDS）,multiple organ dysfunction syndrome（MODS） and so on.Results In group A,fluid volume of achieving positive fluid balance was more,and PT was longer than those in group B（P〈0.05）.There were no statistical differences in time of achieving resuscitation goal,MAP and Scv O26 h after resuscitation between two groups（P〉0.05）.Mortality rate and total incidence rate of complication in group A were higher than those in group B（P〈0.05）,while there were no statistical differences in incidence rates of ARF,DIC,ARDS,MODS and other complications between two groups（P〉0.05）.Conclusion PVI has good response on fluid resuscitation for patients with hemorrhagic shock,and it can be sensitively monitored and reflect status of circulatory blood volume with less fluid volume,so it is conducive to maintain steady state of internal environment homeostasis with higher survival rate and lower incidence rate of complication,and therefore it has high clinical value on improving monitoring,diagnosis and treatment and prognosis of patients.