PetCO2的变化联合被动抬腿试验在脓毒性休克机械通气患者容量反应性的应用

Application of PetCO2 change combined with PLR in predicting fluid responsiveness in septic shock patients with mechanical ventilation

目的探讨PetCO 2的变化联合被动抬腿试验在脓毒性休克机械通气患者容量反应性的临床应用价值。方法选择2017年6月至2019年03月我院ICU病房收治的脓毒性休克机械通气患者56例。分别在基线、被动抬腿试验、容量负荷试验前后监测患者PetCO 2和血流动力学参数(心率HR、收缩压SBP、舒张压DBP、平均动脉压MAP、中心静脉压CVP、每搏量SV、每博变异率SVV、心指数CI)变化。以容量负荷试验△CI的值分为两组(有容量反应组和无容量反应组),以接受者操作特征曲线(ROC曲线)分析被动抬腿试验后PetCO 2的变化对容量反应性的预测价值。结果56例患者中,31例有容量反应性(有容量反应组),25例无容量反应性(无容量反应组)。PLR后有容量反应性组血流动力学参数(HR、SBP、DBP、MAP、SV、SVV、CI)和PetCO 2水平较无容量反应性组对比显著升高(P<0.05)。被动抬腿试验后,△CIPLR与△PetCO 2PLR呈正相关(r=0.685,P=0.012)。PLR后△CIPLR预测容量反应性的ROC曲线下面积为0.863±0.062(95%CI 0.761~0.964;P<0.05),以15%为临界值,敏感性为83.9%,特异性84.0%;PLR后△PetCO 2PLR预测容量反应性的ROC曲线下面积为0.828±0.055(95%CL 0.719~0.936;P<0.05),以4.5%为临界值,敏感性为66.7%,特异性92.0%。结论PLR中PetCO 2的变化能反映脓毒性性休克机械通气患者心输出量的变化,可以对容量复苏过程中容量反应性起到良好预测作用。

Objective To explore the application of of PetCO 2 change combined with PLR in predicting fluid responsiveness in septic shock patients with mechanical ventilation.Methods 56 septic shock patients with mechanical ventilation in ICU admitted from June 2017 to March 2019 were prospectively recruited.The changes of PetCO 2 and hemodynamic parameters(heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial blood pressure(MAP),central venous pressure(CVP),stroke volume(SV),stroke volume variation(SVV),cardiac index(CI))were monitored respectively at baseline,after PLR and after volume expansion.The value of CI in VE was divided into two groups(the fluid responsiveness group and the non-fluid responsiveness group).The predictive value of the change of PetCO 2 after PLR was analyzed by receiver operating characteristic curve(ROC curve).Results A total of 56 patients were enrolled in this study,31 of whom had CI increase of≥15%after volume expansion(the fluid responsiveness group)and 25 had CI increase of<15%after volume expansion(the non-fluid responsiveness group).After PLR,the hemodynamic parameters(HR,SBP,DBP,MAP,SV,SVV,CI)and PetCO 2 levels in the fluid responsiveness group were significantly higher than those in the baseline group(P<0.05),while CVP levels in the non-fluid responsiveness group were significantly higher than those in the baseline group(P<0.05).After PLR,△CIPLR was positively correlated with△PetCO 2PLR(r=0.685,P=0.012).The area under ROC curve of△CIPLR for predicting fluid responsiveness after PLR was 0.863±0.062(95%CI 0.761~0.964;P<0.05).Taking 15%as the critical value,the sensitivity was 83.9%,and the specificity was 84.0%.The area under the ROC curve of△PetCO 2PLR for predicting fluid responsiveness after PLR was 0.828±0.055(95%CL 0.719~0.936;P<0.05).Taking 4.5%as the critical value,the sensitivity was 66.7%,and the specificity was 92.0%.Conclusion The changes of PetCO 2 in PLR can reflect the changes of CO in septic shock patients with mechanical ventilation and can predict fluid responsiveness during volume resuscitation.