不同监测方式对老年脓毒性休克患者容量反应性的价值分析

Evaluation of Volumetric Reactivity in Senile Septic Shock by Different Monitoring Methods

目的探究不同监测方式对老年脓毒性休克患者容量反应性的价值。方法选取我院2016年4月至2018年4月收治的60例老年脓毒性休克患者作为研究对象,对全部患者行序贯器官衰竭估计评分(SOFA)和APACHE-Ⅱ评分,采用被动抬腿试验(PLRT)和补液试验,结合PiCCO技术,对PLRT前后和补液前后的各项体征指标水平进行检测,包括心率、中心静脉压、动脉收缩压、平均动脉压等。根据体征检测的情况,对患者进行分组,分组有反应组和无反应组,评价PLRT对容量反应的预测价值。结果在PLRT实验方面,有反应组和无反应组实验前后HR、CVP、SAP、MAP、PP、PCCI、SV等指标的差值相比较,差异无统计学意义(P> 0. 05);在补液测试方面,有反应组和无反应组测试前后HR、CVP、SAP、MAP、PP、PCCI、SV等指标的差值相比较,差异无统计学意义(P>0. 05)。PLRT-ΔSV (PLRT诱导的每搏量变化率)与补液试验后ΔSV (补液试验诱导的每搏量变化率)呈正相关(r=0. 91,P<0. 05); PLRT-ΔPP与ΔSV呈正相关(r=0. 84,P<0. 05)。结论 PLRT联合PiCCO应用在老年脓毒性休克患者容量反应的预测中,具有较高的价值,值得临床推广应用。

Objective To explore the value of different monitoring methods for volumetric reactivity of senile septic shock patients.Methods 60 cases of elderly patients with septic shock from April 2016 to April 2018 in our hospital were selected as the research objects,who received line sequential organ failure rating(SOFA)and APACHE-Ⅱgrading.The levels of various physical signs before and after rehydration indexes and PLRT were tested by means of passive leg lifts experiment(PLRT)and rehydration,combined with PiCCO technology,including the central venous pressure,artery systolic blood pressure,heart rate,mean arterial pressure,etc.Patients were divided into two groups,the reactive group and the non-reactive group,to evaluate the predictive value of PLRT for volumetric response.Results In PLRT experiment,there were no significant differences between HR,CVP,SAP,MAP,PP,PCCI,SV and other indicators(P>0.05)before and after the experiment in response group and non-response group.In the aspect of fluid replacement test,there were no significant differences between HR,CVP,SAP,MAP,PP,PCCI and SV(P>0.05).PLRT-ΔSV(PLRT induction stroke volume change rate)and rehydration after testΔSV(rehydration test induced stroke volume change rate)were positively correlated(r=0.91,P<0.05),PLRT-ΔPP was positively related withΔSV(r=0.84,P<0.05).Conclusion The application of PLRT combined with PiCCO in the prediction of volumetric response in elderly patients with septic shock is of high value and worthy of clinical application.