Prediction and Correlation Analysis of Hemodynamic Parameters and Volume Responsiveness in Patients with Septic Shock
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    Abstract:

    Objective To explore the changes of hemodynamic parameters in septic shock patients before and after volume stress test, and their predictive value to the volume response of patients. Methods A total of 98 septic shock patients were selected for clinical research. According to the stroke volume change ( ΔSV) of patients before and after rehydration treatment, the patients were divided into 53 cases of volume load positive group ( ΔSV≥15% ) and 45 cases of volume load negative group ( ΔSV< 15% ) . The pulseindicated continuous cardiac output ( PICCO ) and echocardiogram related indexes for two groups of patients before and after the volume load test were compared, and the receiver operating curve ( ROC) was used to analyze the value of statistically significant indexes for septic shock to the patient’ s response to the volume load test. A logistics regression model was used to analyze the relationship between various parameters and the volume load test response. Results Before the volume load test, the measured cardiac output ( CO) , cardiac index ( CI) , stroke volume variation ( SVV) , central venous pressure ( CVP) , heart rate ( HR ) values of patients in two groups were compared, and the difference was not statistically significant ( P>0. 05) . After the test, the CO, CI, and CVP values of volume load positive group were all higher than those of volume load negative group ( P<0. 05) , and the HR and SVV values were lower than those of volume load negative group ( P < 0. 05 ) . Before the volume load test, there was no significant difference in measured left ventricular outflow tract inner diameter velocity-time integral ( LVOT VTI) , LVOT peak flow velocity respiratory variability, and VEpeak values of patients between two groups ( 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 was lower than volume load negative group ( P<0. 05) . ROC curve result showed that for HR, CO, CI, CVP, SVV, LVOT peak flow velocity respiratory variability, LVOT VTI index prediction, the positive area under the curve( AUC) values of the volume load response were 0. 515, 0. 560, 0. 556, 0. 499, 0. 898, 0. 912, 0. 922, respectively. Logistic regression model result showed that 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 LVOT peak flow velocity respiratory variability, these were independent risk factors for the negative volume load test in septic shock patients ( P< 0. 05) . Conclusions Closely monitoring the relevant hemodynamic parameters of patients with septic shock has a clinical value for predicting the patient ’ s volume load response, and it can guide patients in clinical fluid resuscitation.

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DOGN Qianqian, YANG Yan, LIU Dezhi. Prediction and Correlation Analysis of Hemodynamic Parameters and Volume Responsiveness in Patients with Septic Shock[J]. Journal of medical biomechanics,2023,38(6):1219-1225

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History
  • Received:March 23,2023
  • Revised:May 05,2023
  • Adopted:
  • Online: December 25,2023
  • Published: December 25,2023