床旁超声在脓毒症休克患者补液中的应用价值

Application Value of Bedside Ultrasound in Fluid Infusion of Patients with Septic Shock

本文探讨床旁超声下腔静脉直径(IVCD)、下腔静脉扩张指数(dIVC)与脓毒症休克补液容量反应性的关系及意义。选取脓毒症休克患者140例,均给予补液治疗,分析容量反应阳性和阴性患者临床资料差异。容量反应阳性患者吸气末IVCD、呼气末IVCD明显低于容量反应阴性患者(P<0.05)。吸气末IVCD、呼气末IVCD与每搏输出量(SV)呈正相关(P<0.05),dIVC与SV呈负相关(P<0.05)。Logistic回归分析显示:吸气末IVCD、呼气末IVCD、dIVC是容量反应阳性的影响因素(P<0.05)。dIVC预测容量反应阳性的ROC曲线下面积为0.924,明显高于吸气末IVCD和呼气末IVCD的0.789和0.837(P<0.05)。床旁超声在脓毒症休克补液治疗中具有较好的应用价值,其测定的IVCD、dIVC是容量反应的影响因素,其中dIVC预测容量反应性的价值较高。

This paper investigated the relationship and significance between bedside ultrasound inferior vena cava diameter(IVCD),distensibility index of the inferior vena cava(dIVC)and fluid volume responsiveness in septic shock.140 patients with septic shock were selected and treated with fluid therapy,and then the clinical data of patients with positive and negative volume reaction were analyzed.The end inspiratory IVCD and end expiratory IVCD in patients with positive volume response were significantly lower than those in patients with negative volume response(P<0.05).There was a positive correlation between end inspiratory IVCD,end expiratory IVCD and stroke volume(SV)(P<0.05),and the dIVC was negatively correlated with SV(P<0.05).Logistic regression analysis showed that end inspiratory IVCD,end expiratory IVCD and dIVC were the influencing factors of positive volume response(P<0.05).The area under the ROC curve of positive volume response predicted by dIVC was 0.924,which was significantly higher than that of IVCD at the end of inspiration(0.789)and expiration(0.837),(P<0.05).Bedside ultrasound has a good application value in the treatment of septic shock fluid infusion.The IVCD and dIVC are the influencing factors of volume response,and dIVC has a higher value in predicting volume response.