动态动脉弹性预测脓毒性休克患者补液后血压反应的研究

Value of dynamic arterial elastance to predict arterial pressure response to volume loading in elderly septic shock patients

目的探讨老年脓毒性休克患者发生低血压且伴有容量反应性时,动态动脉弹性(dynamic arterial Elasticity,Eadyn)对快速补液后血压反应性的预测价值。方法纳入2016年10月-2019年12月中国人民解放军第三〇五医院重症监护病房收治的老年脓毒性休克患者47例,采取搏指示连续心输出量(pulse-indicated continuous cardiac output,PICCO)监测,补液前记录相关血流动力学数据,予以快速补液治疗,补液完成后再次采集PICCO血流动力学数据,以△MAP↑>15%作为阳性组,△MAP↑<15%作为阴性组。对比两组患者快速补液治疗前后的平均动脉压(mean arterial pressure,MAP)、全心舒张末期容积(global end-diastolic volume index,GEDVI)、心输出量指数(cardiacindex,CI)、每搏量指数(Stroke Volume Index,SVI)、全身血管阻力(Systemic vascular resistance index,SVRI)、每搏量变异(stroke volume variation,SVV)、脉压变异(pulse pressure variation,PPV)、静态动脉弹性(Arteral Elasticity,Ea)以及动态动脉弹性(Eadyn),并进行Logistic逐步回归分析和ROC分析明;确上述指标与血压反应性的关系和预测价值。结果阳性组患者补液前MAP、GEDVI、SVI、CI、PPV、SVV、SVRI以及Ea与阴性组均无明显统计学差异(P>0.05),但Eadyn要明显高于阴性组(P<0.05)。Logistic逐步回归分析提示补液前Eadyn是补液治疗后血压反应性的独立危险因素,其OR为1.118(95%CI 1.015~1.232,P=0.024),ROC分析显示补液前Eadyn预测快速补液后血压有反应的AUC为0.737(95%CI 0.590~0.884,P=0.006),截断值为84.41%(灵敏度65.38%,特异度85.71%)。结论Eadyn对老年脓毒性休克患者低血压时快速补液治疗后血压变化有良好的预测价值。

Objective To explore the predictive value of dynamic arterial elasticity(Eadyn)on the blood pressure response after volume loading in elderly septic shock patients with hypotension and fluid responsiveness.Methods 47 elderly patients with septic shock aged>65 underwent intravenous infusion of 500 mL saline through central venous catheter within 30 minutes when manifestations of hypotension were shown.Pulse-indicated continuous cardiac output(PICCO)and other related hemodynamic parameters,mean arterial pressure(MAP),global enddiastolic volume(GEDVI),cardiac output index(CI),stroke volume index(SVI),systemic vascular resistance(SVRI),stroke volume variation(SVV),pulse pressure variation(PPV),arterial elasticity(EA)and dynamic arterial elasticity(Eadyn)were recorded before and after the volume loading.The patients with △MAP↑>15%were included in the positive group(n=26),and those with the △MAP↑<15%were included in the negative group(n=21).The relater parameters of the two groups were compared.Logistic regression analysis was carried out to look for the independent risk factors.Furthermore,ROC analysis was used to prove the predictive value.Results There were no significant differences in the values of MAP,GEDVI,SVI,Cl,PPV,SVV,SVRI and EA between the positive and negative groups(all P>0.05),however,the Eadyn level of the positive group was significantly higher than that of the negative group(P<0.05).Logistic stepwise regression analysis showed that baseline Eadyn,with an OR level of 1.118(95%CI 1.015-1.232,P=0.024)was an independent risk factor for blood pressure response after rehydration.ROC analysis showed that the area under curve(AUC)of baseline Eadyn was 0.737(95%CI 0.590-0.884,P=0.006),and the cutoff value was 84.41%(sensitivity 65.38%,specificity 85.71%).Conclusion The Eadyn level can predict blood pressure response to fluid therapy in elderly patients with septic shock.