摘要
目的探讨潮气量负荷试验(TVC)在机械通气脓毒症患者容量反应性评估中的作用。方法纳入2017年1月至2017年12月兰州大学第一医院重症医学科(ICU)收治的72例行机械通气的脓毒症患者,记录基础特征,首先以潮气量(Vt)6 mL/kg(理想体质量)进行机械通气,监测脉压差变异度(PPV6)和每搏输出量变异度(SVV 6),然后进行TVC,即将Vt由6 mL/kg增加至8 mL/kg维持2 min,监测PPV8和SVV8。TVC结束后继续以Vt 6 mL/kg通气并稳定10 min,再进行改良被动抬腿试验(PLRT),记录PLRT前后心脏指数(CI)变化,以PLRT后ΔCI%≥10%定义为容量反应阳性,将患者分为无反应组和有反应组,同时计算TVC前后PPV变化值(ΔPPV)和SVV变化值(ΔSVV)。结果纳入患者中无反应组32例,有反应组40例,两组患者的性别、年龄、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官功能障碍(SOFA)评分、呼吸功能、血流动力学指标以及TVC前的中心静脉压(CVP)、CI、脉压差变异度(PPV)、每搏输出量变异度(SVV)差异均无统计学意义(P>0.05)。TVC后有反应组患者PPV8和SVV8较PPV6和SVV6显著增加(P<0.05),而无反应组患者无明显变化(P>0.05);两组患者PPV8(13.3±4.5 vs.7.3±3.2,P<0.01)和SVV8(14.6±5.6 vs.7.8±3.5,P<0.01)差异有统计学意义。PPV8和SVV8对容量反应性评估的准确性较PPV6和SVV6均增高(P<0.01),而TVC前后ΔPPV和ΔSVV对患者的容量反应性有最好的预测价值,曲线下面积(AUROC)分别为0.97和0.95。结论机械通气脓毒症患者进行TVC后PPV变化值(ΔPPV)和SVV变化值(ΔSVV)可以准确预测其容量反应性。
Objective To explore the effect of tidal volume challenge(TVC)on fluid responsiveness in patients with sepsis during mechanical ventilation.Methods Seventy-two mechanical ventilation patients with sepsis were enrolled in the department of critical care medicine(ICU)of our hospital from January 2017 to December 2017.The basic characteristics of all patients were recorded.The patients were firsdy ventilated with tidal volume(Vt)6 mL/kg(ideal weight),and the pulse pressure variability(PPV6)and stroke volume variability(SVV6)were recorded.Then tidal volume challenge(TVC)was carried out,which increased Vt from 6 mL/kg to 8 mL/kg for 2 minutes,and PPV8 and SVV8 were recorded.After the completion of TVC,all the patients continued to ventilate with Vt 6 mL/kg and maintained for 10 minutes,followed by the passive leg raising test(PLRT).A PLRT induced increase in cardiac index(CI)of at least 10%was defined as fluid responder.The patients were divided into non-responders group and responders group.The change values of PPV and SVV(△PPV and△SVV)were calculated after TVC.Results Thirty-two patients were non-responders and the other 40 were responders.There were no significant differences in sex,age,APACHE II score,SOFA score,respiratory function,hemodynamic index and CVP,Cl,PPV and SVV before TVC between the two groups.After TVC,there was a significant increase in PPV8 and SVV8 compared with PPV6 and SVV6 in the responders group(P<0.05),but there was no significant change in the non-responders group.PPV8 and SVV8 of the two groups were also statistically different(PPV8:13.3±4.5 vs.7.3±3.2,P<0.01;SVV8:14.6±5.6 vs.7.8±3.5,P<0.01).The accuracy of PPV8 and SVV8 in the evaluation of capacity reactivity was higher than that of PPV6 and SVV6(P<0.01).While the△PPV and△SVV were the best predictor of volume responsiveness(AUROC:0.97 and 0.95.Conclusion With tidal volume challenge,△PPV and△SVV can accurately predict the fluid responsiveness of septic patients with mechanical ventilation.
作者
窦志敏
林庆玲
曹永强
李斌
刘健
Dou Zhi - min;Lin Qing - ling;Cao Yong - qiang;Li Bin;Liu Jian(Department of Critical Care Medicine,The First Hospital of Lanzhou University,Lanzhou 730000,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2019年第4期366-370,共5页
Chinese Journal of Critical Care Medicine
