被动抬腿试验和容量负荷试验评估ICU感染性休克患者容量反应性的意义

Significance of passive leg raising test and volume capacity test in the assessment of volume response of patients with septic shock in ICU

目的探讨被动抬腿试验(PLR)和容量负荷试验(VE)评估ICU感染性休克患者容量反应性的意义。方法选取2010年5月至2015年5月我院ICU收治的感染性休克患者100例作为研究对象。所有患者依次行PLR和VE。记录基线、PLR和VE后心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、每搏量(SV)、胸腔内血容量(ITBV)和全心舒张末期容量(GEDV)等数据。对比分析有容量反应性患者和无容量反应性患者血流动力学变化。采用ROC曲线分析PLR和VE预测感染性休克患者容量性反应的价值。结果 100例参与试验的患者中有容量反应性48例,无容量反应性52例。有容量反应性组患者在PLR和VE后,CVP和SV均较基线明显升高,差异均有统计学意义(P<0.05);组内比较,两组患者HR、MAP、CVP、SV、ITBV和GEDV在PLR和VE后的变化比较差异均无统计学意义(P>0.05)。Pearson相关分析显示,PLR后△SV与VE后△SV存在显著正相关性(r=0.460,P=0.001);PLR后△SV曲线面积为0.880(95%CI:0.786~0.973),VE后△SV曲线面积为0.859(95%CI:0.760~0.958),二者比较差异无统计学意义(P>0.05);在PLR期间,当△SV为14.5%时诊断容量反应性的灵敏度为77.3%,特异度为85.7%;在VE期间,当△SV为13.1%时诊断容量反应性的灵敏度为72.7%,特异度为75.0%。结论 PLR和VE对感染性休克患者容量反应性的评估价值高于CVP、ITBV、GEDV等指标,结合△SV则拥有较高的灵敏度和特异性。

Objective To investigate the significance of passive leg raising(PLR) test and volume load(VE)test in the assessment of volume response of septic shock patients in ICU. Methods A total of 100 patients with septic shock were selected as the research subjects in our hospital from May 2010 to May 2015. All patients were given PLR and VE. The baseline data, heart rate(HR), mean arterial pressure(MAP), central venous pressure(CVP), stroke volume(SV), intrathoracic thoracic blood volume(ITBV) and global end diastolic volume(GEDV) after PLR and VE were recorded. Comparative analysis of hemodynamic changes was performed in patients with or without volume response. Receiver operating characteristic(ROC) curve was used to predict the value of VE and PLR in the assessment of volume response in patients with septic shock. Results Among 100 patients, there were 48 patients with volume response(volume response group) and 52 patients without volume response(no volume response group). In volume response group,the CVP and SV were significantly higher than baseline after PLR and VE(P<0.05). There were no significant differences of each index(HR, MAP, CVP, SV, ITBV, GEDV) between the two groups after PLR and VE(P>0.05). Pearson correlation analysis showed that △SV and △SV after PLR and VE had a significant positive correlation(r=0.460, P=0.001).The area under ROC curve(ROC-AUC) of △SV after PLR was 0.880(95% CI: 0.786~0.973) and the ROC-AUC of△SV after VE was 0.859(95% CI: 0.760~0.958), with no statistically significant difference(P>0.05). During the PLR period, when SV was 14.5%, the sensitivity and specificity were 77.3% and 85.7% in the diagnosis of volume response.During the VE period, when SV was 13.1%, the sensitivity and specificity were 72.7% and 75.0% in the diagnosis of volume response. Conclusion PLR and VE have higher value than CVP, ITBV, GEDV in assessing volume response of patients with septic shock, and the combination with the △SV results in higher sensitivity and specificity.