心脏超声联合被动抬腿试验评价脓毒性休克患者容量反应性的价值

Value of Cardiac Ultrasound Combined with Passive Leg Raising Test in Volume Responsiveness Assessment of Septic Shock Patients

目的探讨心脏超声联合被动抬腿试验对脓毒性休克患者容量反应性的评估价值。方法选择2013年7月至2014年6月上海交通大学医学院附属同仁医院收治的脓毒性休克患者50例,按照随机数字法分为观察组(25例)和对照组(25例)。观察组行被动抬腿试验(PLR),对照组行容量负荷试验(VE);分别于PLR、VE前后采用心脏超声监测心率、中心静脉压(CVP)、平均动脉压(MAP)、心排血量(CO)、每搏量(SV),比较各组间指标的变化水平。结果两组患者试验前心率、CVP、MAP、CO、SV比较差异均无统计学意义(P>0.05);试验后,两组CVP[观察组:(6.2±0.7)cm H_2O(1 cm H_2O=0.098 k Pa)比(5.1±0.6)cm H_2O;对照组:(6.1±0.8)cm H_2O比(5.3±0.7)cm H_2O]、CO[观察组:(4.0±0.7)L/min比(3.4±0.3)L/min;对照组:(3.9±0.5)L/min比(3.5±0.3)L/min]、SV[观察组:(30.7±3.4)m L比(26.4±3.1)m L;对照组:(31.1±3.7)m L比(26.6±2.8)m L]均较试验前显著增加(P<0.05);试验后观察组与对照组心率、CVP、MAP、CO、SV比较差异均无统计学意义(P>0.05)。结论心脏超声联合PLR能够监测脓毒性休克患者的容量反应性,且安全性更高,当患者存在扩容禁忌证时,可以采用PLR预测容量反应性,从而避免容量负荷过载的风险。

Objective To explore the value of cardiac ultrasound combined with passive leg raising（PLR） test in volme responsiveness assessment of septic shock patients. Methods A total of 50 septic shock patients treated in Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from Jul. 2013 to Jun. 2014 were included in study, and divided into an observation group and a control group according to the random number method, 25 cases each. The observation group performed PLR, and control group performed volume estimation （VE）. The heart rate （HR）, central venous pressure （ CVP）, mean arterial pressure （ MAP）, cardiac output （CO）, stroke volume （SV） were detected by cardiac ultrasound before and after PLR, VE, and the changes of the indexes of each group were compared. Results There was no significant difference in HR, CVP, MAP, CO and SV between the two groups before the test （P 〉 0. 05 ）. After test, CVP [observation group：（6.2±0.7） cmH2O vs （5.1 ±0.6） cmH20; control group： （6.1 ±0.8） cmH20 vs （5.3 ± 0. 7 ） cmH20 ], CO [ observation group ： （4. 0 ± 0. 7 ） L/min vs （3. 4 ± 0. 3 ） L/min; control group ： （ 3.9 ± 0.5 ） L/min vs （3.5 ±0. 3） L/mini ,SV[ observation group： （30.7 ±3.4） mL vs （26.4±3. 1） mL; control group： （31.1 ±3.7） mL vs （26. 6 ±2. 8） mL] were significantly increased（P 〈0. 05） ,after test HR,CVP,MAP,CO,SV of the two groups bad no statistically significant difference（ P 〉 0.05 ）. Conclusion Cardiac ultrasound combined with PLR can be used to predict the volume responsiveness in patients with septic shock, with higher safety,in the case of patients with expansion contraindica- tions, PLR can be used to predict the volume responsiveness, so as to avoid the risk of volume overload.