天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (4): 470-473.doi: 10.11958/20150040

• 临床研究 • 上一篇    下一篇

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

李婷， 阚艳敏△， 马琳， 白静， 张军伟   

  1. 河北唐山， 华北理工大学附属医院超声科 （邮编063000）
  • 收稿日期:2015-07-20 修回日期:2015-11-26 出版日期:2016-04-15 发布日期:2016-05-20
  • 通讯作者: △通讯作者 E-mail： wuxiny_2009@163.com E-mail:tangshankym@163.com
  • 作者简介:李婷 （1988）， 女， 硕士在读， 主要从事超声医学研究

Study on the clinical value of bedside ultrasound in evaluating the fluid responsiveness in patients with septic shock

LI Ting, KAN Yanmin△, MA Lin, BAI Jing, ZHANG Junwei   

  1. Department of Ultrasound, the Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, China
  • Received:2015-07-20 Revised:2015-11-26 Published:2016-04-15 Online:2016-05-20
  • Contact: △Corresponding Author E-mail :wuxiny_2009@163.com E-mail:tangshankym@163.com

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摘要： 摘要： 目的 探讨床旁超声预测重症监护病房 （ICU） 感染性休克患者容量反应性的临床价值。方法 对 2015 年 1 月—4 月我院 ICU 收治的 42 例进行机械通气的感染性休克患者进行补液试验， 补液试验前后均采用超声测量获得每搏量 （SV）、 主动脉峰值流速呼吸变异率 （△VpeakAO ）、 下腔静脉扩张指数 （△IVC） 以及肱动脉最大速度变异率（△VpeakBA ）， 并记录临床各项指标。根据对补液的反应将患者分为有反应 （R） 组和无反应 （NR） 组， 比较 2 组间上述指标的差异， 以及△IVC、 △VpeakAO、 △VpeakBA 与△SV 的相关性， 采用 ROC 曲线评价补液前△IVC、 △VpeakAO 以及 △VpeakBA预测感染性休克患者的容量反应性的应用价值。结果 42例患者进行补液试验47例次， R组25例次， NR 组 22 例次。补液前， R 组的△IVC、 △VpeakAO 和△VpeakBA 均高于 NR 组； △IVC、 △VpeakAO 以及△VpeakBA 与△SV 呈正相关； △IVC、 △VpeakAO 以及△VpeakBA 曲线下面积分别为 0.825、 0.853、 0.866， 均有较高的特异度和敏感度。结论 床旁超声测定的血流动力学指标能够预测 ICU 机械通气感染性休克患者液体治疗时的容量反应性， 特异度和敏感度较高， 可用于指导其液体治疗。

关键词: 休克,脓毒性, 超声心动描记术, 每搏输出量, 血流动力学, 补液疗法, 床旁超声, 容量反应性

Abstract: Abstract： Objective To study the clinical value of bedside ultrasound in predicting the fluid responsiveness in pa⁃ tients with septic shock in intensive care unit (ICU). Methods Forty- two mechanically ventilated patients with septic shock who admitted to ICU of the Affiliated Hospital of North China University of Science and Technology from January 2015 to April 2015 were included in this study. All patients were treated with volume expansion (VE) text. Hemodynamics in⁃ dexes were obtained by ultrasound before and after each test, including stroke volume (SV), aortic peak blood flow velocity variation rate of breathing (△VpeakAO), inferior vena cava expansion index (△IVC) and brachial artery maximum speed vari⁃ ation rate (△VpeakBA). Clinical data and central venous pressure (CVP) were recorded. Based on the responsiveness of SV, patients were divided into responsive group (R) and non-responsive group (NR), respectively. The differences of the above in⁃ dexes were compared between two groups. The correlation of △IVC, △VpeakAO, △VpeakBA and △SV was determined. The role of the hemodynamic index for predicting volume responsiveness was evaluated by receiver operating characteristic ROC curves. Results A total of 47 VE tests were performed in 42 patients, 25 in R group and 22 in NR group. Before VE test, the hemodynamics indicators of △IVC, △VpeakAO and △VpeakBA were significantly higher in R group compared with those of NR group (P < 0.05). The values of △IVC, △VpeakAO and △VpeakBA were positively correlated with △SV in two groups. The areas under the ROC curve of the hemodynamics indicators were 0.825, 0.853 and 0.866 for △IVC, △VpeakAO and △VpeakBA, and they all showed high sensitivity and specificity. Conclusion The hemodynamic index measured by bedside ultrasound can predict the volume responsiveness in mechanically ventilated patients with septic shock fluid therapy, and which can be used to fluid therapy with a high degree of specific and sensitivity in clinical practice.

Key words:  shock, septic, echocardiography, stroke volume, hemodynamics, fluid therapy, bedside ultrasound, fluid responsiveness