血流动力学参数与脓毒症休克患者容量反应性的预测及相关性分析
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新乡市中心医院/新乡医学院第四临床学院 重症医学科二区

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Prediction and correlation analysis of hemodynamic parameters and volume responsiveness in patients with septic shock
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    摘要:

    目的 探讨容量负荷试验前后脓毒症休克患者血流动力学参数的变化及对患者发生容量反应的预测价值、相关性。方法 选取我院收治的脓毒症休克患者98例进行临床研究,根据补液治疗前后患者的每搏输出量变化值(△SV)是否≥15%分为容量负荷阳性组53例、容量负荷阴性组45例,对比两组患者容量负荷试验前后的脉搏波连续心排量法(PICCO)、超声心动图相关指标,并采用受试者工作曲线(ROC)分析具有统计学意义的指标对于脓毒症休克患者发生容量负荷试验反应性的价值,采用logistics回归模型分析各项参数与容量负荷试验反应的关系。结果 在容量负荷试验前,容量负荷阳性组与容量负荷阴性组患者的CO、CI、SVV、CVP、HR测定值比较,差异均无统计学意义(P>0.05);试验后,容量负荷阳性组的CO、CI、CVP测定值均高于容量负荷阴性组(P<0.05),HR、SVV值均低于容量负荷阴性组(P<0.05);在容量负荷试验前,容量负荷阳性组与容量负荷阴性组患者的LVOT VTI、LVOT峰值流速呼吸变异度、VEpeak测定值比较,差异均无统计学意义(P>0.05);试验后,容量负荷阳性组的LVOT VTI测定值高于容量负荷阴性组(P<0.05),LVOT峰值流速呼吸变异度低于容量负荷阴性组(P<0.05);ROC曲线结果显示CO、CI、SVV、CVP、HR、LVOT峰值流速呼吸变异度、LVOT VTI各项指标预测容量负荷反应阳性的AUC值分别为0.515、0.560、0.556、0.499、0.898、0.912、0.922;Logistic回归模型结果显示:APACHEⅡ评分越高、SOFA评分越高、CO越低、CI越低、CVP越低、SVV越高、LVOT VTI越低、LVOT峰值流速呼吸变异度越大是脓毒症休克患者容量负荷试验阴性的独立危险因素(P<0.05)。结论 密切监测脓毒症休克患者的相关血流动力学参数,对于预测患者容量负荷反应性具有重要的临床价值,对于指导患者临床液体复苏具有重要意义。

    Abstract:

    Objective? To explore the changes of hemodynamic parameters in septic shock patients before and after volume stress test and their predictive value and correlation to the volume response of patients.? Methods? 98 cases of septic shock patients admitted to our hospital were selected for clinical research. According to whether the stroke volume change (△SV) of patients before and after rehydration treatment was ≥15%, they were divided into 53 cases of volume load positive group and 45 cases of volume load negative group. For example, compare the pulse wave continuous cardiac output method (PICCO) and echocardiogram related indexes before and after the volume load test of the two groups of patients, and use receiver operating curve (ROC) to analyze the statistically significant indexes for septic shock The value of the patient"s response to the volume load test is analyzed using a logistics regression model to analyze the relationship between various parameters and the volume load test response. Results? Before the volume load test, the CO, CI, SVV, CVP, HR measured values ??of the volume load positive group and the volume load negative group were compared, and the difference was not statistically significant (P>0.05); after the test, the volume load positive group The CO, CI, and CVP values ??were all higher than the volume load negative group (P<0.05), and the HR and SVV values ??were lower than the volume load negative group (P<0.05); before the volume load test, the volume load positive group and the volume load The comparison of LVOT VTI, LVOT peak flow velocity respiratory variability, and VEpeak measurement values ??of patients in the negative group was not statistically significant (P>0.05); after the test, the LVOT VTI measurement value of the positive volume load group was higher than that of the negative volume load group ( P<0.05), LVOT peak flow velocity respiratory variability is lower than volume load negative group (P<0.05); ROC curve results show CO, CI, SVV, CVP, HR, LVOT peak flow velocity respiratory variability, LVOT VTI index prediction The positive AUC values ??of the volume load reaction were 0.515, 0.560, 0.556, 0.499, 0.898, 0.912, 0.922; Logistic regression model results showed: the higher the APACHEⅡ score, the higher the SOFA score, the lower the CO, the lower the CI, and the lower the CVP The higher the SVV, the lower the LVOT VTI, and the greater the respiratory variability of the LVOT peak flow rate were independent risk factors for the negative volume load test in patients with septic shock (P<0.05).? Conclusion Closely monitoring the relevant hemodynamic parameters of patients with septic shock has important clinical value for predicting the patient"s volume load responsiveness, and is of great significance for guiding patients in clinical fluid resuscitation.

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  • 收稿日期:2023-03-23
  • 最后修改日期:2023-05-17
  • 录用日期:2023-05-18
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