IVC-RVI联合血清炎症因子水平预测脓毒症休克患者容量反应性的价值

Predictive value of IVC-RVI combined with serum inflammatory factor levels onvolumetric reactivity in patients with septic shock

目的 探讨下腔静脉内径呼吸变异度(IVC-RVI)联合血清炎症因子水平预测脓毒症休克患者容量反应性的临床价值。方法 选取锦州市中心医院2019年6月—2021年6月120例脓毒症休克患者作为研究对象,根据容量负荷试验将患者分为有反应组(n=52)和无反应组(n=68)。于容量负荷试验前采用超声测定患者吸气末下腔静脉最大内径(D_(max))、呼气末下腔静脉最小内径(D_(min)),计算IVC-RVI。于患者入院时测定血清炎症因子[白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]。借助ROC分析D_(max)、D_(min)、IVC-RVI、IL-6、CRP、TNF-α对脓毒症休克患者有容量反应性的预测价值,通过一致性分析,评估D_(max)、D_(min)、IVC-RVI联合IL-6、CRP、TNF-α对脓毒症休克患者有容量反应性的预测价值。结果 有反应组D_(max)、D_(min)显著低于无反应组,IVC-RVI显著高于无反应组,比较差异有统计学意义(P<0.05)。有反应组血清IL-6、CRP、TNF-α水平均显著低于无反应组,比较差异有统计学意义(P<0.05)。经ROC分析,D_(_(max))、D_(min)、IVC-RVI、IL-6、CRP、TNF-α预测脓毒症休克患者有容量反应性的曲线下面积分别为0.836、0.846、0.804、0.903、0.877、0.756,均有P<0.05。经一致性分析,120例脓毒症休克患者中联合预测阳性51例,敏感度为0.981,特异性为0.971,准确率为0.975,Kappa为0.949。结论 IVC-RVI和血清炎症因子水平均可用于脓毒症休克患者容量反应性预测中,且联合检测可获得更好的敏感度、特异性。

Objective To investigate the clinical value of respiratory variability index of inferior vena cava diameter(IVC-RVI)combined with serum inflammatory factors in predicting volumetric reactivity in patients with septic shock.Methods 120 patients with septic shock in Jinzhou Central Hospital from June 2019 to June 2021 were selected as the research object.According to the volume load test,the patients were divided into reactive group(n=52) and non reactive group(n=68).The _(max)imum inner diameter(D_(max)) and _(min)imum inner diameter(D_(min)) of the inferior vena cava at the end of respiration were measured by ultrasound,and IVC-RVI was calculated.Fasting peripheral blood samples were collected at admission to test the serum interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α).ROC was used to analyze the predictive value of D_(max),D_(min),IVC-RVI,IL-6,CRP and TNF-α in patients with septic shock.The predictive value of D_(max),D_(min),IVC-RVI combined with IL-6,CRP and TNF-α in patients with septic shock was evaluated by consistency analysis.Results The values of D_(max)and D_(min)of the responding group were significantly lower than those of the non-responding group,and the values of IVC-RVI was significantly higher than that of the non-responding group(all P<0.05).The levels of IL-6,CRP,and TNF-α of the responding group were all significantly lower than those of the non-responding group(all P<0.05).ROC analysis showed that the area under the curve of D_(max),D_(min),IVC-RVI,IL-6,CRP and TNF-α for predicting volumic reactivity in patients with septic shock were 0.836,0.846,0.804,0.903,0.877,and 0.756 respectively(all P<0.05).According to consistency analysis,51 of the 120 patients with septic shock were positive for combined prediction,with a sensitivity of 0.981,specificity of0.971,accuracy of 0.975 and Kappa of 0.949.Conclusion Both IVC-RVI and serum inflammatory factor levels can be used to predict volumetric reactivity in patients with septic shock,and combined detection can achieve better sensitivity and specificity.