下腔静脉呼吸变异率在脓毒症休克中的应用价值
摘要
目的评估下腔静脉呼吸变异率,预测肺炎所致的脓毒症休克患者容量反应性的临床价值。方法选取2016年03月至2017年02月就诊于我院治疗的肺炎所致脓毒症休克机械通气患者62例,进行前瞻性研究。依据被动抬腿试验(PLRT)的结果,将所有患者分为容量反应性阳性组及容量反应性阴性组。比较两组下腔静脉内径及呼吸变异率的差异。结果容量反应性阳性组下腔静脉最大径1. 53±0. 05,最小径1. 06±0. 04,下腔静脉呼吸变异率为0. 37±0. 15;容量反应性阴性组下腔静脉最大径2. 06±0. 07,最小径1. 83±0. 07,下腔静脉呼吸变异率为0. 12±0. 15。两组下腔静脉最大径、最小径及呼吸变异率比较均有明显差异,均P <0. 01。下腔静脉呼吸变异率预测容量反应性的最佳值为20. 5%,敏感度89. 7%,特异度100%,曲线下面积99. 4%。结论下腔静脉呼吸变异率在评估肺炎所致的感染性休克患者的容量反应性方面具有重要的临床价值。补液过程中反复测量下腔静脉呼吸变异率,能够动态的反应容量反应性,从而指导临床补液。
引文
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[20]张龙,邱淑华.被动抬腿试验预测液体复苏后心功能不全患者容量反应性的价值[J].海南医学,2018,29(1):24-28.
[21]司向,黄牧云,陈娟,等.被动抬腿试验对脓毒症合并心功能不全患者液体反应性的预测价值[J].中华危重病急救医学,2015,27(9):729-734.
[2] WIEDEMANN H P,WHEELER A P,BERNARD G R,et al. Comparison of two fluid management strategies in acute lung injury[J]. N Engl J Med,2006,354(24):2564-2575.
[3]姜天俊,辛邵杰,郭晓东,等.急性传染病休克的临床诊治与转归分析[J].现代生物医学进展,2012,12(22):4288-4290.
[4] SINGER M,DEUTSCHMAN C S,SEYMOUR C W,et al. The Third international Consensus Definitions for Sepsis and septic Shock(Sepsis-3)[J]. JAMA,2016,315(8):801-810.
[5] KIRKPATRICK A W,ROBERTS D J,DE WAELE J,et al. Intraabdominal hypertension and the abdominal compartment syndrome:updated consensus definitions and clinical practice guidelines from the world Society of the Abdominal Compartment Syndrome[J]. Intensive Care Med,2013,39(7):1190-1206.
[6] THOMAS M,SHILLINGFORD J. The circulatory response to a standard postural change in ischaemic heart disease[J]. Br Heart J,1965,27:17-27.
[7]王伟,林锦乐,张文武,等.被动抬腿实验联合Vigileo指导休克患者液体复苏与管理的临床研究[J].中华急诊医学杂志,2014,23(6):678-683.
[8]郭志利,王勇强.被动抬腿试验评估感染性休克患者容量反应性的临床研究[J].医学理论与实践,2015,28(8):983-985.
[9]李晓勇,刘易林,邓芸.被动抬腿试验联合心脏超声心动图预测感染性休克患者容量反应性的价值[J].吉林医学,2016,37(7):1579-1582.
[10] DRES M,TEBOUL J L,ANGUEL N,et al. Passive leg raising performed before a spontaneous breathing trial predicts weaning-induced cardiac dysfunction[J]. Intensive Care Med,2015,41(3):487-494.
[11] GEERTS B,DE WILDE R,AARTS L,et al. Pulse contour analysis to assess hemodynamie response to passive leg raising[J]. J Cardiothorac Vasc Anesth,2011,25(1):48-52.
[12] BIAIS M,VIDIL L,SARRABAY P,et al. Changes in stroke induced by passive leg raising in spontaneously breathing patients:comparison between echocardiography and vigileo TM/Flo Trac TMdevice[J]. Crit Care,2009,13(6):R195.
[13] BLEHAR D J,DIEKMAN E,GASPARI R. Identification of congestive heart failure via respiratory variation of inferior vena cava diameter[J]. Am J Emerg Med,2009,27(1):71-75.
[14] SCHMIDT G A,KOENIG S,MAYO P H. Shock:ultrasound to guide diagnosis and therapy[J]. Chest,2012,142(4):1042-1048.
[15] SEIF D,MAILHOT T,PERERA P,et al. Caval sonography in shock:a noninvasive method for evaluating intravascular volume in critically ill patients[J]. J Ultrasound Med,2012,31(12):1885-1890.
[16]庄燕,王醒.超声心动图在重症患者容量状态评估中的应用[J].东南大学学报(医学版),2013,32(1):125-127.
[17]毛艳卿,喻晓东,李扬麟,等.血液透析患者下腔静脉直径/体表面积变化及意义[J].山东医药,2014,54(3):20-22.
[18] FEISSEL M,MICHARD F,FALLER J P,et al. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy[J].Intensive Care Med,2004,30(9):1834-1837.
[19]李婷.应用床旁超声评估感染性休克患者容量反应性的临床价值[D].唐山:华北理工大学,2016.
[20]张龙,邱淑华.被动抬腿试验预测液体复苏后心功能不全患者容量反应性的价值[J].海南医学,2018,29(1):24-28.
[21]司向,黄牧云,陈娟,等.被动抬腿试验对脓毒症合并心功能不全患者液体反应性的预测价值[J].中华危重病急救医学,2015,27(9):729-734.