股动脉峰值血流速度呼吸变化率对感染性休克患者容量反应性的评估

ASSESSMENT OF VOLUME RESPONSIVENESS OF FEMORAL ARTERY PEAK FLOW VELOCITY WITH SEPTIC SHOCK PATIENTS

目的评价股动脉峰值血流速度呼吸变化率(ΔVpeakCFA)对预测重症监护病房(ICU)感染性休克患者容量反应性的准确性。方法选取2017年6月—2018年2月收治于华北理工大学附属医院ICU进行机械通气的46例感染性休克患者进行容量负荷试验。试验前后均采用超声测量每搏量(SV)以及股动脉峰值血流速度呼吸变化率,并记录临床各项指标如性别、年龄、体重指数(BMI)、潮气量(TV)、呼吸频率(RR)以及左室射血分数(LVEF)。根据对容量负荷试验的SV的变化(ΔSV)将患者分为有反应组(R)和无反应组(NR),分析各参数与ΔSV的关系,并评估各项指标对预测容量反应性的临床价值。结果46例患者进行容量负荷试验52例次,R组28例次,NR组24例次。容量负荷试验前,R组的ΔVpeakCFA的值均高于NR组的值;ΔVpeakCFA与ΔSV显著相关;ΔVpeakCFA的ROC曲线下面积及95%置信区间分别为0.925(0.851~0.998),且有较高的特异度和敏感度。结论股动脉峰值血流速度呼吸变化率能准确地预测ICU感染性休克患者在进行机械通气时的容量反应性。

Objective To evaluate the accuracy of change rate of peak blood flow velocity of femoral artery with respiration(ΔVpeakCFA)in predicting volume responsiveness in patients with septic shock in intensive care unit(ICU).Methods Forty-six patients with septic shock who were treated with mechanical ventilation in ICU of the Affiliated Hospital of North China University of Science and Technology from June 2017 to February 2018 were selected in this study and tested by volume loading test.Ultrasound was used to measure stroke volume(SV)and peak blood flow velocity of femoral artery before and after the experiment,and clinical indicators including gender,age,body mass index(BMI),tidal volume(TV),respiratory rate(RR)and left ventricular ejection fraction(LVEF)were recorded.According to the change of SV in volume load test(SV),patients were divided into reactive group(R)and non-reactive group(NR).The relationship between parameters and SV was analyzed,and the clinical value of each index before volume load test for predicting volume responsiveness was evaluated.Results A total of 52 VE tests in 46 patients were evaluated and 28 responders and 24 non-responders were identifisd.Before VE test,theΔVpeakCFA of responsive group washigher than non-responders.ΔVpeakCFA was significantly related toΔSV;the area under the ROC curve and 95%confidence interval of the hemodynamics indicators ofΔVpeakCFA was 0.925(0.851-0.998),and it has high sensitivity and specificity.Conclusion Ultrasound hemodynamic parameters can predict the volume responsiveness of ICU patients with mechanical ventilation septic shock accurately.