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-  2015 

应用每搏输出量变异率和胸腔内血容量指数评估保留自主呼吸的机械通气感染性休克患者的容量反应性

DOI: doi:10.7507/1671-6205.2015086

Keywords: 感染性休克, 每搏输出量变异率, 胸腔内血容量指数, 容量反应性

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Abstract:

目的探讨保留自主呼吸的机械通气感染性休克患者的容量反应性评估中, 每搏输出量变异率(SVV)和胸腔内血容量指数(ITBVI)的应用价值。 方法采用前瞻性临床观察研究, 选取2013年6月至2014年6月在广州医科大学附属第一医院重症医学科接受脉搏指示连续心排出量监测(PiCCO)的感染性休克患者, 收集患者的液体复苏数据。所有患者液体复苏前后均进行经肺热稀释测量, 并记录心排指数(CI)、ITBVI、SVV、中心静脉压(CVP)等参数。根据液体复苏前后CI增加率是否达到15%或以上分为有反应组17例, 无反应组12例。对SVV、ITBVI、CVP和CI变化率(ΔCI)进行Pearson相关分析, 为SVV、ITBVI、CVP建立判断容量反应性的受试者工作特征(ROC)曲线并比较曲线下面积。 结果有反应组患者液体复苏前CI、ITBVI比无反应组低(P<0.05), 而两组间SVV差异无统计学意义(P>0.05)。相关分析显示复苏前ITBVI与ΔCI有显著相关(r=-0.593, P<0.001), 而SVV、CVP与ΔCI之间无显著相关(r=0.037, P=0.847;r=0.198, P=0.302)。SVV、ITBVI、CVP的ROC曲线下面积分别为0.640(P=0.207)、0.865(P=0.001)、0.463(P=0.565)。ITBVI为784 mL/m2时, 预测容量反应性的敏感性为100.0%, 特异性为70.6%。 结论在保留自主呼吸的机械通气感染性休克患者中, ITBVI可以作为比SVV更好的容量反应性预测指标

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