床旁超声检测对感染性休克患者容量反应性预测的价值研究

Clinical value of bedside ultrasonography for evaluation of fluid responsiveness in patients with septic shock

目的探讨床旁超声预测对感染性休克患者容量反应性的临床价值。方法选取ICU进行机械通气的感染性休克患者92例,对其进行容量负荷试验,根据补液后心脏每博量(SV)增加值(ΔSV)是否≥15%分为有反应组48例和无反应组44例。通过床旁超声检测两组患者血流动力学指标心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、下腔静脉呼吸变异率(ΔIVC)、主动脉峰值流速呼吸变异率(ΔVpeak_(AO))、肱动脉最大速度变异率(ΔVpeak_(BA)),并进行比较,并通过ROC曲线评价相关指标预测容量反应性的效果。结果两组患者补液前血流动力学指标HR、MAP、CVP差异均无统计学意义(均P>0.05),有反应组患者ΔIVC、ΔVpeak_(AO)、ΔVpeak_(BA)均明显高于无反应组(均P<0.05),补液后两组患者HR、MAP与补液前差异均无统计学意义(均P>0.05),有反应组患者CVP较补液前明显升高(P<0.05),ΔIVC、ΔVpeak_(AO)、ΔVpeak_(BA)均较补液前明显降低(均P<0.05),无反应组患者CVP较补液前明显升高(P<0.05),ΔIVC、ΔVpeak_(AO)、ΔVpeak_(BA)与补液前差异均无统计学意义(均P>0.05);ROC曲线分析结果显示,ΔIVC、ΔVpeak_(AO)、ΔVpeak_(BA)以及3者拟合预测AUC分别为0.714、0.808、0.821、0.937,ΔIVC、ΔVpeak_(AO)、ΔVpeak_(BA)间AUC差异均无统计学意义(均P>0.05),ΔIVC、ΔVpeak_(AO)、ΔVpeak_(BA) AUC均明显低于三者拟合预测AUC(均P<0.05)。结论应用床旁超声测量的ΔIVC、ΔVpeak_(AO)、ΔVpeak_(BA)能够对ICU机械通气感染性休克患者进行容量反应性预测,可对其液体治疗进行指导。

Objective To evaluate the application of bedside ultrasonography for fluid responsiveness in patients with septic shock. Methods Ninety two patients with septic shock admitted in ICU of Pytuo District Hospital from June 2015 to August2016 were enrolled in the study. According to volume loading test, the patients were divided into response group(48 cases) and non-response group(44 cases). Hemodynamic indexes HR, MAP, CVP, ΔIVC, ΔVpeak_(AO) and ΔVpeak_(BA) were tested by bedside ultrasonography in 2 groups, and the values of each index for of fluid responsiveness were assessed by ROC analysis.Results There were no significant differences in HR, MAP and CVP between 2 groups before fluid infusion(P >0.05), while ΔIVC,ΔVpeak_(AO) and ΔVpeak_(BA) in response group were significantly higher than those in non-response group before fluid infusion(P<0.05). Compared with before fluid infusion, HR and MAP in both groups had no significant difference after fluid infusion(P >0.05).CVP in response group after fluid infusion was significantly higher than that before fluid infusion(P<0.05), ΔIVC, ΔVpeak_(AO) andΔVpeak_(BA) in response group after fluid infusion were significantly lower than those before fluid infusion(P<0.05). CVP in non-response group after fluid infusion was significantly higher than that before fluid infusion(P<0.05), ΔIVC, ΔVpeak_(AO) andΔVpeak_(BA) in non-response group after fluid infusion had no significant difference with those after fluid infusion(P >0.05). ROC analysis showed that area under curve(AUC) of ΔIVC, ΔVpeak_(AO), ΔVpeak_(BA) and combination of 3 indicators were 0.714, 0.808,0.821 and 0.937 respectively. The AUC of combination of three indicators was higher than those of ΔIVC, ΔVpeak_(AO) and ΔVpeak_(BA) individually(P <0.05), there was no significant difference in AUC among three indexes(P >0.05). Conclusion Hemodynamic indexes ΔIVC, Δ Vpeak_(AO) and Δ Vpeak_(BA) measured by bedside ultrasonography can be used for evaluation of fluid responsiveness in ICU mechanical ventilation patients with septic shock.