中心静脉血氧饱和度和下腔静脉管径呼吸变异指数可预测脓毒性休克非机械通气容量反应

Central venous oxygen saturation and inferior vena cava diameter respiratory variability index can predict the non mechanical ventilation volume response in septic shock

目的:探讨中心静脉血氧饱和度(ScvO_(2))、下腔静脉管径呼吸变异指数(IVC-rvi)对脓毒性休克非机械通气患者容量反应的预测价值及其与心肌损伤的关系。方法:选取2019年1月至2020年6月河北北方学院附属第一医院重症医学科收治的96例脓毒性休克非机械通气患者,均实施容量负荷试验,将心指数增加率≥10%记为容量反应阳性,其中容量反应阳性组52例,容量反应阴性组44例。检测并比较2组患者ScvO_(2)、IVC-rvi和心肌损伤指标[包括肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)、N-末端脑钠肽前体(NT-proBNP)]。采用受试者工作特征曲线评价ScvO_(2)、IVC-rvi对容量反应阳性的评估价值;采用Pearson法分析患者ScvO_(2)、IVC-rvi与心肌损伤指标的相关性。结果:容量反应阳性占比54.17%;容量反应阳性组患者ScvO_(2)高于容量反应阴性组患者,IVC-rvi、cTnT、cTnI、NT-proBNP水平低于容量反应阴性组患者(P均<0.05)。ScvO_(2)、IVC-rvi预测容量反应阳性的最佳截断值分别为64.93%、53.52%,二者联合预测容量反应阳性的灵敏度与单独预测相当,特异度和曲线下面积均高于单独预测;ScvO_(2)与cTnT、cTnI、NT-proBNP水平均呈负相关,IVC-rvi与cTnT、cTnI、NT-proBNP水平均呈正相关(P均<0.05)。结论:ScvO_(2)、IVC-rvi可预测脓毒性休克非机械通气容量反应,且二者与心肌损伤均有相关性。

Objective:To analyze the value of central venous oxygen saturation(ScvO_(2))and inferior vena cava diameter respiratory variability index(IVC-rvi)in the prediction of volume response in patients with septic shock,and to explore the relationship between them and myocardial injury.Methods:A total of 96 patients with septic shock who were not mechanically ventilated in Department of Critical Care Medicine of the First Affiliated Hospital of Hebei North University from January 2019 to June 2020 were enrolled in this study.The positive volume response was recorded as the increase rate of cardiac index≥10%,and there were 52 cases in the volume reaction positive group and 44 cases in the volume reaction negative group.ScvO_(2),IVC-rvi and myocardial injury indexes[including troponin T(cTnT),troponin I(cTnI),N-terminal pro brain natriuretic peptide(NT-proBNP)]were detected in all patients,and compared between patients with positive and negative volume response.Receiver operating characteristic(ROC)curve was used to evaluate the value of ScvO_(2) and IVC-rvi in the prediction of positive volumetric response.Pearson method was used to analyze the correlation between ScvO_(2),IVC-rvi and myocardial injury indexes.Results:The positive rate of volume reaction was 54.17%.The ScvO_(2) was higher,the IVC-rvi,cTnT,cTnI and NT-proBNP levels were lower in patients with positive volume response than those in patients with negative volume response,with statistically significant differences(P<0.05).The cut-off values of ScvO_(2) and IVC-rvi were 64.93%and 53.52%in the prediction of positive volume reaction,respectively.The sensitivity of ScvO_(2) combined with IVC-rvi was similar to that of ScvO_(2) or IVC-rvi alone,and the specificity and the area under the curve(AUC)of ScvO_(2) combined with IVC-rvi were higher than those of ScvO_(2) or IVC-rvi alone.ScvO_(2) was negatively correlated with cTnT,cTnI and NT-proBNP,and IVC-rvi was positively correlated with cTnT,cTnI and NT-proBNP(P<0.05).Conclusion:ScvO_(2) and IVC-rvi can predict the non mechanical ventilation volume response in septic shock,and they are correlated with myocardial injury.