摘要
目的探讨重症超声技术在脓毒症休克液体复苏者容量反应中的预测效能及意义。方法选取2020年1月—2022年6月北京怀柔医院收治的84例脓毒症休克患者,根据被动抬腿试验(PLR)前后每搏量指数变化分为有反应组(45例,每搏量指数变化率≥15%)、无反应组(39例,每搏量指数变化率<15%),比较两组颈总动脉峰值流速度变异率(ΔVpeakCA)、PLR前后速度时间积分差值(ΔVTI)、PLR前后校正血流时间差值(ΔFTc),应用Pearson分析ΔVTI、ΔFTc、ΔVpeakCA与每搏量指数变化率的相关性,采用偏相关性分析每搏量指数变化率的相关影响因素,采用受试者工作特征曲线(ROC)分析ΔVTI、ΔFTc、ΔVpeakCA及联合预测容量反应的效能。结果两组间比较发现,无反应组ΔVTI、ΔFTc、ΔVpeakCA、每搏量指数变化率低于有反应组(P<0.05);Pearson相关性分析显示,ΔVTI、ΔFTc、ΔVpeakCA与每搏量指数变化率呈正相关(r=0.818、0.742、0.848,均P<0.001);偏相关性分析显示,ΔVTI、ΔFTc、ΔVpeakCA均与每搏量指数变化率相关(P<0.05);ROC分析显示,ΔVTI、ΔFTc、ΔVpeakCA及联合的ROC下面积(AUC)分别为0.828、0.796、0.839、0.949,三者联合的敏感度为92.31%,特异度为88.89%。结论ΔVTI、ΔFTc、ΔVpeakCA与行机械通气的脓毒症休克患者液体复苏容量反应性有关,通过重症超声技术可实现以上参数的无创、便捷检测,对患者容量反应性作出有效预测,从而帮助指导临床进行液体复苏治疗。
Objective To investigate the predictive efficacy and significance of critical ultrasound technology in fluid resuscitator from septic shock.Methods A total of 84 patients with septic shock who were admitted to Beijing Huairou Hospital from January 2020 to June 2022 were selected.According to the change of stroke volume index before and after passive leg raising test(PLR),they were divided into the response group(45 cases,the change of stroke volume index).Variation rate of peak flow velocity of common carotid artery(ΔVpeakCA),velocity time integral difference before and after PLR(ΔVTI),corrected blood flow time difference before and after PLR(ΔFTc)were compared.Pearson was used to analyze the correlation betweenΔVTI,ΔFTc,ΔVpeakCA and the rate of change of stroke volume index,and partial correlation was used to analyze the related influencing factors of the rate of change of stroke volume index.The performance ofΔVTI,ΔFTc,ΔVpeakCA and their combination in predicting volume response was analyzed using the receiver operating characteristic curve(ROC).Results The comparison between the two groups showed that the change rates ofΔVTI,ΔFTc,ΔVpeakCA and stroke volume index in the non-responding group were lower than those in the responding group(P<0.05);Pearson correlation analysis showed thatΔVTI,ΔFTc,ΔVpeakCA were positively correlated with the change rate of stroke volume index(r=0.818,0.742,0.848,all P<0.001);Partial correlation analysis showed thatΔVTI,ΔFTc andΔVpeakCA were all correlated with the change rate of stroke volume index(P<0.05);The ROC analysis showed that the AUCs ofΔVTI,ΔFTc,ΔVpeakCA and their combination were 0.828,0.796,0.839,and 0.949,respectively,with a sensitivity of 92.31%and a specificity of 88.89%.ConclusionΔVTI,ΔFTc,ΔVpeakCA are related to fluid resuscitation volume responsiveness in septic shock patients undergoing mechanical ventilation.Critical ultrasound technology can achieve non-invasive and convenient detection of the above parameters,effectively predict patient volume responsiveness,and help guide clinical practice to Perform fluid resuscitation.
作者
魏向颖
姚振刚
郭霂星
WEI Xiangying;YAO Zhengang;GUO Muxing(Surgical Intensive Care Unit,Beijing Huairou Hospital,Beijing 101400,China)
出处
《中国急救复苏与灾害医学杂志》
2023年第7期892-896,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
北京市卫生科技发展专项基金(编号:2018-4-101)。
关键词
重症超声技术
脓毒症休克
液体复苏
容量反应
预测效能
Critical ultrasound technology
Septic shock
Fluid resuscitation
Volume response
Predictive performance
