床旁心脏超声联合被动抬腿试验在感染性休克患者容量反应性评估中的应用价值探讨

Application value of bedside cardiac ultrasound combined with passive leg raising test in the assessment of capacity reactivity in patients with septic shock

目的 探讨床旁心脏超声联合被动抬腿试验（PLR）在感染性休克患者容量反应性评估中的应用价值.方法 筛选在2015-10～2016-10期间河北北方学院附属第一医院收治的感染性休克患者61例作为研究对象,检测患者在平卧位时床旁心脏超声血流动力学指标,再先后对患者进行PLR和容量负荷试验（VE）,并分别检测心脏超声血流动力学指标变化情况,对比分析有容量反应性组和无反应组的血流动力学指标.结果 61例患者中,29例有容量反应性,占全部患者47.54％（29/61）.有反应性和无反应性两组患者在PLR和VE前的血流动力学基线值HR、MAP、CVP、SV和CO的组间比较差异均无统计学意义（P＞0.05）;经PLR和VE后,两组间HR、MAP的变化微小,差异均无统计学意义（P＞0.05）,两组CVP均上升,与基线值相较,两组变化均有统计学意义（P＜0.05）;两组SV值也较基线上升,但无反应组和基线比较差异无统计学意义（P＞0.05）,有反应组和基线比较差异有统计学意义（P＜0.05）;且有反应组对应SV值高于无反应组（P＜0.05）;两组CO均较基线升高,但无反应组变化微小,与基线比较差异无统计学意义（P＞0.05）,有反应组和基线比较差异有统计学意义（P＜0.05）.Pearson相关性分析显示,PLR-ΔSV和扩容后ΔSV呈现正相关关系（r=0.812,P ＜0.05）.结论 床旁心脏超声联合PLR用于感染性休克患者容量反应性评估效果较好,对临床液体治疗有一定的指导意义.

Objective To discuss the application value of bedside cardiac ultrasound combined with passive leg raising （PLR） test in the assessment of capacity reactivity in patients with septic shock.Methods 61 patients with septic shock from October 2015 to October 2016 were objects of this study.Echocardiographic hemodynamic indices in horizontal position were detected.PLR and volume load test （VE） for patients were detected successively to detect the changes of echocardiographic hemodynamic indexes.The hemodynamic indices between the volume reactivity group and the nonreactive group were compared.Results 29 had capacity response in the 61 patients,accounting for 47.54％ （29/61）.The baseline values differences of hemodynamics HR,MAP,CVP,SV and CO before PLR and VE of reactivity group and non-reactivity group were not statistically significant （P ＞ 0.05）.After PLR and VE,the changes of HR and MAP between the two groups were not statistically significant （P ＞ 0.05）.The two groups of CVP were all rising,compared with the baseline,the two groups were statistically significant （P ＜ 0.05）.The two groups of SV values were also higher than the baseline;compared with baseline data,there was no statistical difference in non-reactivity group （P ＞ 0.05）.Compared with baseline data,there was statistical difference in reactivity group （P ＜ 0.05）.The corresponding SV value in the reaction group was higher than that in the non-reactive group （P ＜ 0.05）.The two groups of CO were all higher than the baseline,but the changes in the non-reactivity group were not significant （P ＞ 0.05）.And compared with baseline data,there was statistical difference in reactivity group （P ＜ 0.05）.Pearson correlation analysis shows a positive correlation between PLR-ASV and dilatation of ASV （r =0.812,P ＜ 0.05）.Conclusion Bedside cardiac ultrasound combined with passive leg raising test can be used for capacity reactivity in patients with septic shock.Its application effect is better and has certain guiding significance for clinical liquid treatment.