被动抬腿试验对感染性休克患者的容量反应性评价

Passive leg raising test in evaluation of volume response in infective shock patients

目的探讨被动抬腿(PLR)试验对进行早期液体复苏的感染性休克患者的容量反应性评价。方法选取51例感染性休克患者进行PLR试验和液体复苏,根据液体复苏结果将患者分为有反应组[扩容后每搏输出量(SV)较PLR前增加≥15%,27例]和无反应组(扩容后SV较PLR前增加<15%,24例)。在PLR前、PLR时、扩容前和扩容后各时间点,监测患者的SV、心输出量(CO)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)等血流动力学指标的变化。根据PLR试验后SV对患者补液的容量反应性绘制ROC曲线,计算其AUC,并分析其相关性。结果有反应组PLR时和扩容后的SV、CO、CVP均显著大于同组PLR前(P值分别<0.01、0.05),组内各时间点间HR、MAP的差异均无统计学意义(P值均>0.05);无反应组组内各时间点间SV、CO、HR、MAP、CVP的差异均无统计学意义(P值均>0.05)。有反应组PLR时、扩容前和扩容后的SV分别较同组PLR前增加(12.1±6.6)、(8.3±5.1)和(20.8±4.7)mL,无反应组PLR时、扩容前和扩容后的SV分别较同组PLR前增加(4.7±5.4)、(-0.4±3.3)和(4.1±2.8)mL,有反应组PLR时、扩容前和扩容后SV的改变值均显著大于无反应组(P值均<0.01)。PLR试验后SV对患者补液容量反应性的ROC曲线的AUC为0.756(P=0.009);患者PLR试验后SV越小,其补液容量反应性越好,且SV为47.5 mL时尤登指数最大(为0.560)。结论 PLR试验可有效评估进行早期液体复苏的感染性休克患者的容量反应性。

Objective To investigate the role of passive leg raising （PLR） test in evaluating volume responsiveness of early fluid resuscitation in septic shock patients. Methods Fifty-one patients with septic shock were divided into reaction group （fluid resuscitation test was positive, n = 27） and non-response group （fluid resuscitation test was negative, n = 24） according to fluid resuscitation results. Hemodynamic indexes, such as stroke volume （SV）, cardiac output （CO）, heart rate （HR）, mean arterial pressure （MAP） and central venous pressure （CVP）, were monitored before PLR, during PLR, before fluid resuscitation and during resuscitation. According to SV at the end of PLR, ROC curve about the fluid reaction was made and the area under the receiver operating characteristic curve （AUC） were calculated. Results In reaction group, SV, CO and CVP after PLR and fluid resuscitation were significantly increased as compared with those before PLR （P 〈0. 01 or 0.05）% however, there were no significant differences in HR or MAP between the four time points （all P〈0.05）. In non- response group, no significant differences were found in SV, CO, HR, MAP or CVP before PLR, during the PLR, before fluid resuscitation or during resuscitation （all P〉0.05）. Compared with those before PLR, in reaction group, SV increased by （12.1±6.6） mL during PLR （P〈0.01）, SV increased by （8.3 ±5.1） mL before fluid resuscitation （P〈0.05） and SV increased by （20.8±4.7） rnL during fluid resuscitation （P〈0.01）. In non- reaction group, compared with that before PLR, SV increased by （4.7±5.4） mL, （-0.4±3.3） mL and （4.1 ± 2.8） mL during PLR, before and after fluid resuscitation, respectively （all P〈O. 05）. The changes of SV in reaction group were significantly higher than those in non-reaction group during PLR, before and after fluidresuscitation （all P〈0.01）. After PLR, less SV was, associated with better fluid responsiveness when SV was 47.5 mL, Yoden index reached the peak （0. 560） and AUC was 0. 756 （ P = 0. 009）. Conclusion PLR test can effectively evaluate the volume responsiveness in septic shock patients with early fluid resuscitation.