中心静脉压联合下腔静脉呼吸变异度在脓毒性休克患者液体复苏中的预测价值

Predictive value of central venous pressure combined with inferior vena cava respiratory variability in fluid resuscitation of patients with septic shock

目的:探讨中心静脉压(CVP)联合下腔静脉呼吸变异度(VIVC)在脓毒性休克患者液体复苏中的预测价值。方法:选择92例脓毒性休克患者为研究对象,依据患者治疗后28 d不同结局分为存活组(n=70)和死亡组(n=22);依据患者CVP高低分为高CVP组(>8 mmHg,n=44)和低CVP组(<8 mmHg,n=48);依据VIVC高低分为高VIVC组(>19.25%,n=21)和低VIVC组(<19.25%,n=71)。比较患者心率(HR)、平均动脉压(MAP)、CVP、VIVC水平、急性生理学及慢性健康状况评分(APACHEⅡ评分)、序贯器官衰竭评分(SOFA评分),ROC曲线分析CVP联合VIVC对脓毒性休克液体复苏容量反应性的预测价值。结果:复苏6、12、24 h后,脓毒性休克患者MAP、CVP、VIVC相较复苏前改善,差异有统计学意义(P<0.05)。存活组患者复苏24 h后CVP相较死亡组升高(P<0.05),VIVC、APACHEⅡ评分、SOFA评分相较死亡组降低(P<0.05)。复苏6 h后,高CVP组患者VIVC、APACHEⅡ评分、SOFA评分及死亡率相较低CVP组降低(P<0.05);CVP相较低VIVC组降低(P<0.05),APACHEⅡ评分、SOFA评分及死亡率相较低VIVC患者升高(P<0.05)。ROC曲线结果显示,CVP联合VIVC预测脓毒性休克液体复苏容量反应性的曲线下面积为0.877,约登指数为1.637,敏感性为81.24%,特异性为82.52%。结论:CVP联合VIVC可用于预测脓毒性休克患者液体复苏容量反应性,对于指导临床液体复苏治疗具有重要意义。

Objective:To explore the predictive value of central venous pressure combined with inferior vena cava respiratory variability in fluid resuscitation of patients with septic shock.Methods:92 patients with septic shock were selected as the research objects.The patients were divided into survival group(n=70)and death group(n=22)according to the different outcomes 28 days after treatment,patients were divided into high CVP group(>8mmhg,n=44)and low CVP group(<8mmhg,n=48)according to the level of CVP,according to the level of VIVC,they were divided into high VIVC group(>19.25%,n=21)and low VIVC group(<19.25%,n=71).The levels of HR,MAP,CVP,VIVC,acute physiology and chronic health score(APACHE II score)and sequential organ failure score(SOFA score)were compared.ROC curve was drawn to evaluate the predictive value of CVP combined with VIVC for fluid resuscitation volume responsiveness in septic shock.Results:MAP,CVP and VIVC of septic shock patients after 6 h,12 h and 24 h resuscitation were significantly improved compared with those before resuscitation(P<0.05).After 24 h of resuscitation,CVP in survival group was significantly higher than that in death group(P<0.05),and VIVC,APACHEⅡscore and SOFA score in survival group were significantly lower than those in death group(P<0.05).After 6 h of resuscitation,the scores of VIVC,APACHEⅡ,SOFA and mortality in the high CVP group were significantly lower than those in the low CVP group(P<0.05).CVP in high VIVC group was significantly lower than that in low VIVC group 6 h after resuscitation(P<0.05),APACHEⅡscore,SOFA score and mortality were significantly higher than those in high VIVC group(P<0.05).ROC curve results showed that the area under the curve of CVP combined with VIVC in predicting fluid resuscitation volume responsiveness of septic shock was 0.877,Youden index was 1.637,sensitivity was 81.24%,specificity was 82.52%.Conclusion:CVP combined with VIVC can be used to predict fluid resuscitation volume responsiveness in patients with septic shock,which is of great significance for guiding clinical fluid resuscitation treatment.