浙江医学2017，Vol.39Issue(15)：1265-1268,1296,5.DOI:10.12056/j.issn.1006-2785.2017.39.15.2017-1222
小剂量容量负荷试验联合经胸心脏超声评估感染性休克患者容量反应性的临床价值研究
Low-volume fluid challenge with transthoracic echocardiography in predicting volume responsiveness of septic shock patients
摘要
Abstract
Objective To evaluate the predictive value of low-volume fluid challenge with transthoracic echocardiography for volume responsiveness in mechanically ventilated patients with septic shock.Methods Clinical data of 37 mechanically ventilated patients with septic shock were analyzed prospectively.Hemodynamic parameters were determined by transthoracic echocardiography before fluid challenge (FC),after a 100ml infusion of crystalloid solution over 1 min and a further 400 ml infusion over 15 min.Patients were classified as responders if cardiac output (CO) increased by at least 15％ following the 500ml FC and non-responders if CO increased by less than 15％.Receiver operating characteristic curves (ROC curves) were generated for variations of CO and aortic velocity time index (VTI) after infusion of 100 ml of fluid over 1min (△CO100 and △VTI100).Results Among 37 patients there were 21 responders and 16 non-responders.In all patients,there were positive correlations between △CO100 and △CO500 (r=0.954,P＜0.01),△VTI100 and △CO500 (r=0.762,P＜0.01),respectively.The area under ROC curve (AUC) for △CO100 was 0.961 (95％CI:0.907-1.015).Taking △CO100≥8％ as the cut-off value for predicting fluid responsiveness,the sensitivity and specificity were 95.2％ and 87.5％,respectively.The AUC for △VTI100 was 0.929 (95％CI:0.848-1.009).Taking△VTI100 ≥10％ as cut-off value for predicting fluid responsiveness,the sensitivity and specificity were 85.7％ and 93.8％,respectively.Conclusion △CO100 and △VTI100 measured by transthoracic echocardiography can predict the fluid responsiveness in septic shock patients and it can be used for guiding fluid therapy.关键词
容量负荷试验/主动脉速度时间积分/容量反应性/感染性休克/心输出量Key words
Fluid challenge/Aortic velocity time index/Fluid responsiveness/Septic shock/Cardiac output引用本文复制引用
沈珏,汪沁,刘文生,黄剑,柳开忠..小剂量容量负荷试验联合经胸心脏超声评估感染性休克患者容量反应性的临床价值研究[J].浙江医学,2017,39(15):1265-1268,1296,5.基金项目
浙江省医药卫生科研项目(2016147603kxxbg) （2016147603kxxbg）
