中心静脉血氧饱和度对老年脓毒性休克患者容量反应性的预测价值

Clinical value of central venous Oxygen saturation in predicting fluid responsiveness in elderly patients with septic shock

目的通过比较容量负荷试验前后中心静脉血氧饱和度(ScvO_2)变异度和心输出量(CO)变异度的关系,来判断老年脓毒性休克患者ScvO_2对容量反应性预测价值。方法对符合脓毒性休克诊断标准的45例老年脓毒性休克患者,建立中心静脉导管(CVC)及连续心排血量监测(PICCO);进行容量负荷试验,用250mL 0.9%盐水快速静脉输注,试验前后分别抽取中心静脉导管血做血气分析,记录ScvO_2数值,并记录CO数值;对二者变异度进行t检验,Pearson相关性分析、ROC曲线用来测试指标的反应能力。结果 45例老年脓毒性休克患者容量负荷试验前后平均动脉压(MAP)、心率(HR)、CO、ScvO_2指标比较差异有统计学意义(P<0.05),45例老年脓毒性休克患者容量负荷试验前后CO与ScvO_2呈线性相关(P<0.01)。容量负荷试验前后ScvO_2的变化同CO的变化是密切相关的(r=0.781,P<0.01)。结论 ScVO_2动态变化可以作为判定老年脓毒性休克患者对容量反应性的指标。

Objective To determine the predictive value of central venous oxygen saturation（ScvO2）in volume response by comparing the relationship between variation of ScvO2 and cardiac output（CO）variability before and after volume expansion in elderly patients with septic shock.Methods Forty-five patients who diagnosed septic shock were enrolled in the study,inserted CVC and were carried out continuous cardiac output monitoring（PICCO）before volume expansion.Every patient was treated by rapid intravenous infusion of 250 mL physiological saline,then take blood gas analysis before and after treated which the blood samples were collected from central venous catheter.The value of ScvO2 and the value of cardiac output was recorded.Degree of variation between two sets of data were tested by Student t-test.The correlation was determined by using Pearson′s correlation test.Operating characteristics curve analysis was used to test their ability to distinguish R and NR.Results The mean arterial pressure（MAP）、heart rate（HR）、CO、ScvO2were demonstrated and have statistical significance（P〈0.05）compared with before treated.CO and ScvO2 indexes were positively correlated（P〈0.01）before and after volume expansion.ScvO2 variations after VE were significantly correlated with CO changes after VE（r=0.781,P〈0.01）.Conclusion ScvO2 dynamic changes can be used as a criterion for determining the fluid responsiveness.