不同剂量容量负荷试验在感染性休克老年患者容量反应性评估中的应用价值

Clinical application value of volume load test with different doses to evaluate volume responsiveness in eld-erly patients with septic shock

目的临床对于重症患者补液量尚无统一标准。文中探讨不同剂量容量负荷试验在评估感染性休克老年患者容量反应性的临床价值。方法回顾性分析2018年7月至2019年7月安徽省人民医院重症医学科67例接受机械通气的感染性休克老年患者临床资料。所有患者在30s内快速输注80 mL平衡液后进一步在14.5 min内注入剩余420 mL平衡液。经胸心脏超声技术测定患者在基础状态时、30s、15min时血流动力学变化。在30s内快速输注80mL平衡液后心输出量(CO)增加≥15%患者纳人容量反应性组,反之则为无反应组。计算80mL和500mL补液试验后主动脉速度时间积分(VTI)变化(OVTI)和CO变化(SCO)的敏感性与特异性。通过受试者操作特征(ROC)曲线评价小剂量晶体液容量负荷试验评估感染性休克老年患者容量反应性的价值。结果液体复苏前2组患者年龄、性别、体重、血管活性药物用量、急性生理与慢性健康评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)比较等基线资料比较,差异均无统计学意义(P>0.05)。2组患者均未发生容量过负荷等临床表现。AC080和AVTI80预估容量反应性的ROC曲线下面积分别为0.961和0.929。以SCO80≥15%评判容量反应性,灵敏度为95.2%、特异度为87.5%、约登指数0.827、阳性预测值0.769、阴性预测值0.976;以△VTI80≥15%评价容量反应性,灵敏度为85.7%、特异度为93.8%。结论应用经胸心脏超声监测30s内注射80mL平衡液所引起的CO及VTI变化(△C080及△VTI80)可较准确预估感染性休克老年患者的容量反应性,并作为指导容量治疗的指标。

Objective To evaluate the predictive clinical application value of volume load test with different doses to evaluate volume responsiveness in elderly patients with septic shock.Methods The clinical data of 67 elderly patients with septice shock who received mechanical ventilation in our hospital from July 2018 to July 2019 was analyzed retrospectively.The 80 mL of equilibrium solu-tion was infused rapidly in 30 sec,and then the remaining 420 mL was infused within 14.5 min.Transthoracie echocardiography was used to measure the hemodynamic changes of the patients at basic state,30 sec and 15 min respectively.The increased value of Cardiac Output(CO)after fluid infusion of 80 mL in 30 sec(△CO)≥15%was the responders group,otherwise the non-responders group.The sensitivity and specificity of the changes in VTI and CO after 80 mL and 500 mL rehydration tests were calculated,and then the ROC curve was analyzed.These were used to predict the value of crystal liquid volume loading test with small dose to evaluate volume responsiveness in elderly patients with septic shock.Results There was a significant difference in the responders group(P<0.05),which.was consistent with the change trend of CO after 500 mL liquid resus-citation.There was a positive correlation between 0CO80 and△C0500,OVTI80 and AVTI500 in all patients(r=0.954,0.726,all.P<0.05).The area under ROC curve for△CO80 and AVTI80 was 0.961 and 0.929 respectively.The sensitivity and specificity of SC080≥15%were 95.2%and 87.5%separately,and the sensitivity and specificity of OVTI80≥15%were 85.7%and 93.8%,respectively.Conclusion The changes of CO and VTI(0C080 and△VTI80)caused by the rapid resuscitation of 80 mL equilibrium solution within 30 sec which was measured by transthoracic echocardiography can accurately predict the fluid responsiveness of elderly patients with septie shock,and can be used as an index to guide fluid therapy.