控制性肺膨胀时血流动力学指标对ARDS机械通气患者容量反应性的预测价值

Predictive value of sustained inflation for fluid responsiveness in patients of acute respiratory distress syndrome with mechanical ventilation

目的:探讨控制性肺膨胀(SI)对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)机械通气患者容量反应性的预测价值。方法:将2016年3月至12月在丹阳市人民医院重症医学科行机械通气的ARDS患者纳入研究。监测患者SI前后的血流动力学变化,15 min进行补液试验(FC),根据心指数变化值(ΔCI)将其分为有容量反应性组(FR组,ΔCI≥10%)和无容量反应性组(NFR组,ΔCI<10%)。统计学分析SI时可预测容量反应性的指标,并评估其诊断价值。结果:本研究共纳入40例患者(FR组22例,NFR组18例)。与SI前相比,FR组SI后CI(2.90±0.24 vs 2.61±0.24)、收缩压(SBP)[(102.4±8.0)mm Hg vs(94.0±8.6)mm Hg]差异均有统计学意义(P<0.05)。SI-ΔCI、SI-ΔSBP评估容量反应性的ROC分别为0.934、0.851,敏感度均为90.9%,特异度分别为88.9%、77.8%。结论:SI-ΔCI、SI-ΔSBP可用于评估ARDS机械通气患者的容量反应性。

Objective： To evaluate the predictive value of sustained inflation on fluid responsiveness in patients of acute respiratory distress syndrome（ ARDS） with mechanical ventilation. Methods： The study was conducted in ICU of Danyang People＇s Hospital from March to December in 2016. During this period,ARDS patients with mechanical ventilation were enrolled. We measured the changes in cardiac index（ CI） induced by fluid challenge after15 minutes. Fluid responsiveness was defined by a fluid challenge-induced increase in CI greater than or equal to10%. According to this,patients were divided into two groups-responders（ FR） and non-responders（ NFR）. Logistics analysis was performed to find out the indicators that can predict the responsiveness during SI and then ROC analysis was performed to evaluate the diagnostic value of the indicators. Results： 40 patients were enrolled in the study,22 in the FR group and 18 in the NFR group. Compared with SI,there were significant differences of CI（ 2. 90 ± 0. 24 vs 2. 61 ± 0. 24）（ P〈0. 05） and systolic blood pressure（ SBP） [（ 102. 4 ± 8. 0） mm Hg vs 94. 0 ±8. 6） mm Hg] in FR group. CI and SBP during SI（ SI-ΔCI and SI-ΔSBP） could predict fluid responsiveness,the AUC of SI-ΔCI and SI-ΔSBP was 0. 934 and 0. 851 respectively with the sensitivity of 90. 9% and 90. 9% and specificity of 88. 9% and 77. 8%,respectively. Conclusion： SI-ΔCI,SI-ΔSBP can predict fluid responsiveness of patients in ARDS with mechanical ventilation.