ICU脓毒症休克患者ΔEa、ΔITBVI、ΔVTI与容量反应性关系及预测价值研究

Study on the relationship and predictive value ofΔEa,ΔITBVI,ΔVTI and volume Reactivity in ICU sepsis shock patients

目的研究有效动脉弹性差值(ΔEa)、胸腔内血容量指数差值(ΔITBVI)、颈动脉速度时间积分差值(ΔVTI)与ICU脓毒症休克容量反应性关系及预测价值。方法选取2019年10月至2022年12月该院ICU收治的102例脓毒症休克患者作为研究对象,根据容量负荷试验后有创血流动力监测的心脏指数(CI)变化分为有反应组(CI增加≥15%)、无反应组(CI增加<15%)。比较两组试验前后Ea、ITBVI、VTI、CI及其差值,Pearson法分析ΔEa、ΔITBVI、ΔVTI与ΔCI相关性,Logistic回归分析休克容量反应性的相关影响因素,采用受试者工作特征(ROC)曲线分析效能。结果有反应组试验前Ea高于无反应组,差异有统计学意义(t=4.259,P<0.05),ITBVI、VTI、CI低于无反应组,差异有统计学意义(t=11.454、5.695、7.056,P<0.05);有反应组ΔEa、ΔITBVI、ΔVTI、ΔCI高于无反应组,差异有统计学意义(t=16.580、23.258、20.551、18.948,P<0.05);相关性分析显示,ΔEa、ΔITBVI、ΔVTI与ΔCI呈正相关(r=0.720、0.694、0.771,P<0.05);Logistic分析显示,ΔEa、ΔITBVI、ΔVTI是容量反应性的独立相关影响因素(P<0.05);ROC曲线显示,ΔEa、ΔITBVI、ΔVTI三者联合预测容量反应性的曲线下面积(AUC)大于ΔEa、ΔITBVI、ΔVTI单独预测(P<0.05)。结论ΔEa、ΔITBVI、ΔVTI与ICU脓毒症休克患者容量反应性密切相关,三者联合预测具有一定价值,能为临床指导容量治疗提供参考。

Objective To investigate the relationship and predictive value of effective arterial elasticity difference(ΔEa),intrathoracic blood volume index difference(ΔITBVI),and carotid velocity time integral difference(ΔVTI)with volume responsiveness in ICU septic shock.Methods One hundred and two patients with septic shock admitted to Huizhou Zhongda Huiya Hospital ICU from October 2019 to December 2022 were selected for the study,and were divided into a responsive group(CI increase≥15%)and a nonresponsive group(CI increase<15%)according to the change in cardiac index(CI)on invasive hemodynamic monitoring after the volume loading test.The Ea,ITBVI,VTI,CI and their differences before and after the test were compared between the two groups,Pearson analysis ofΔEa,ΔITBVI,ΔVTI andΔCI correlations,logistic regression analysis of the influencing factors related to volume responsiveness in shock,and subject operating characteristic curve(ROC)analysis of efficacy were used.Results Pre-test Ea was higher in the responsive group than in the non-responsive group,and the difference was statistically significant(t=4.259,P<0.05),and ITBVI,VTI,and CI were lower than in the non-responsive group,and the difference was statistically significant(t=11.454,5.695,7.056,P<0.05);ΔEa,ΔITBVI,ΔVTI,andΔCI were higher in the responsive group than in the non-responsive group,and the difference was statistically significant(t=16.580,23.258,20.551,18.948,P<0.05);Correlation analysis shows that,ΔEa,ΔITBVI,andΔVTI were positively correlated withΔCI(r=0.720,0.694,0.771,P<0.05);logistic analysis showed thatΔEa,ΔITBVI,andΔVTI were independently associated influences on volume responsiveness(P<0.05);ROC curve display,the area under the curve(AUC)ofΔEa,ΔITBVI,andΔVTI together predicted volume responsiveness more than alone(P<0.05).ConclusionΔEa,ΔITBVI,andΔVTI are closely related to volume responsiveness in ICU patients with septic shock,and the combined prediction of the three has some value and can provide a reference for clinical guidance of volume therapy.