本文選題：感染性休克　切入點(diǎn)：被動(dòng)抬腿試驗(yàn)　出處：《上海醫(yī)學(xué)》2016年10期

【摘要】：目的探討被動(dòng)抬腿(PLR)試驗(yàn)對進(jìn)行早期液體復(fù)蘇的感染性休克患者的容量反應(yīng)性評價(jià)。方法選取51例感染性休克患者進(jìn)行PLR試驗(yàn)和液體復(fù)蘇,根據(jù)液體復(fù)蘇結(jié)果將患者分為有反應(yīng)組[擴(kuò)容后每搏輸出量(SV)較PLR前增加≥15%,27例]和無反應(yīng)組(擴(kuò)容后SV較PLR前增加15%,24例)。在PLR前、PLR時(shí)、擴(kuò)容前和擴(kuò)容后各時(shí)間點(diǎn),監(jiān)測患者的SV、心輸出量(CO)、心率(HR)、平均動(dòng)脈壓(MAP)、中心靜脈壓(CVP)等血流動(dòng)力學(xué)指標(biāo)的變化。根據(jù)PLR試驗(yàn)后SV對患者補(bǔ)液的容量反應(yīng)性繪制ROC曲線,計(jì)算其AUC,并分析其相關(guān)性。結(jié)果有反應(yīng)組PLR時(shí)和擴(kuò)容后的SV、CO、CVP均顯著大于同組PLR前(P值分別0.01、0.05),組內(nèi)各時(shí)間點(diǎn)間HR、MAP的差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05);無反應(yīng)組組內(nèi)各時(shí)間點(diǎn)間SV、CO、HR、MAP、CVP的差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。有反應(yīng)組PLR時(shí)、擴(kuò)容前和擴(kuò)容后的SV分別較同組PLR前增加(12.1±6.6)、(8.3±5.1)和(20.8±4.7)mL,無反應(yīng)組PLR時(shí)、擴(kuò)容前和擴(kuò)容后的SV分別較同組PLR前增加(4.7±5.4)、(-0.4±3.3)和(4.1±2.8)mL,有反應(yīng)組PLR時(shí)、擴(kuò)容前和擴(kuò)容后SV的改變值均顯著大于無反應(yīng)組(P值均0.01)。PLR試驗(yàn)后SV對患者補(bǔ)液容量反應(yīng)性的ROC曲線的AUC為0.756(P=0.009);患者PLR試驗(yàn)后SV越小,其補(bǔ)液容量反應(yīng)性越好,且SV為47.5 mL時(shí)尤登指數(shù)最大(為0.560)。結(jié)論 PLR試驗(yàn)可有效評估進(jìn)行早期液體復(fù)蘇的感染性休克患者的容量反應(yīng)性。
[Abstract]:Objective to evaluate the volumetric reactivity of septic shock patients undergoing early fluid resuscitation by passive leg lift PLR test.Methods 51 patients with septic shock were selected for PLR test and fluid resuscitation.According to the results of fluid resuscitation, the patients were divided into two groups: the response group (27 cases with SVV after dilatation) and the non-response group (24 cases with SVV increased by 15% compared with those before PLR after enlargement) and non-response group (n = 24).The changes of hemodynamic parameters such as PLR, cardiac output, heart rate, mean arterial pressure, central venous pressure and so on were monitored at different time points before and after PLR.According to the volume response of SV to rehydration after PLR test, the ROC curve was drawn, and the correlation was analyzed.緇撴灉鏈夊弽搴旂粍PLR鏃跺拰鎵╁鍚庣殑SV,CO,CVP鍧囨樉钁楀ぇ浜庡悓緇凱LR鍓，

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