本文關(guān)鍵詞： 小劑量容量負(fù)荷試驗 膿毒癥 心排血量 液體反應(yīng)性 預(yù)測　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:評估小劑量容量負(fù)荷試驗預(yù)測膿毒癥患者液體反應(yīng)性的預(yù)測價值,為膿毒癥患者的合理擴(kuò)容治療提供一定的臨床參考和理論依據(jù)。方法:選擇2015年8月至2017年1月于我院急診科就診,入院后診斷為膿毒癥需行呼吸機(jī)輔助通氣的患者22例為研究對象。對所有患者給予常規(guī)治療后,予鎖骨下靜脈穿刺置管和股動脈穿刺PICCO置管,實施PICCO監(jiān)測。小劑量容量負(fù)荷前測量HR、MAP、CVP、CO、PPV、SVV、EVLWI為T0,經(jīng)中心靜脈導(dǎo)管在1分鐘內(nèi)快速輸注100ml 0.9%氯化鈉溶液后再次測量上述指標(biāo)為T1,測量結(jié)束30分鐘后繼續(xù)在30分鐘內(nèi)輸注500ml 0.9%氯化鈉溶液,再次測量上述指標(biāo)為T2,每個指標(biāo)連續(xù)測量3次后取平均值。以T2-T0所測CO增加10%定義為容量有反應(yīng)性,根據(jù)對液體反應(yīng)性分為陽性組和陰性組,以T1-T0所測CO的增加率為△CO。所有患者均測量T0、T1、T2三個時間點血管外肺水指數(shù),并統(tǒng)計分析T2和T1同T0比較其結(jié)果是否有統(tǒng)計學(xué)意義。△CO、PPV和CVP的其敏感性與特異性用受試者操作特性曲線(ROC曲線)進(jìn)行分析。結(jié)果:1根據(jù)對液體反應(yīng)性分組后,陽性組12例和陰性組10例,陽性組與陰性組相比,各組患者的一般臨床資料相比無統(tǒng)計學(xué)差異(P0.05)。2小劑量容量負(fù)荷試驗的△CO在ROC曲線下面積為0.85(95%CI:0.695-1.005),最佳敏感性為0.85,特異性為0.70,最佳預(yù)測截點為△CO=0.15。3小劑量容量負(fù)荷試驗中EVLWI在T1期與T0及T2相比結(jié)果無統(tǒng)計學(xué)意義,T2與T0相比T2的EVLWI明顯升高,結(jié)果有統(tǒng)計學(xué)意義(P=0.0001)。4容量反應(yīng)指標(biāo)△CO、PPV、CVP預(yù)測液體反應(yīng)性經(jīng)ROC曲線下面積比較△CO的預(yù)測敏感性及特異性最佳。結(jié)論:1小劑量容量負(fù)荷試驗在膿毒癥患者中應(yīng)用較為安全,△CO可以作為小劑量容量負(fù)荷試驗液體反應(yīng)性的預(yù)測指標(biāo),最佳敏感性為0.85,特異性為0.70。2△CO、PPV對膿毒癥患者液體反應(yīng)性的預(yù)測較CVP敏感。
[Abstract]:Objective: to evaluate the predictive value of low-dose volume-load test in predicting fluid reactivity in septic patients. To provide a certain clinical reference and theoretical basis for the rational treatment of sepsis. Methods: from August 2015 to January 2017 in our emergency department. Twenty-two patients who were diagnosed as sepsis who needed ventilator assisted ventilation were studied. After routine treatment, subclavian vein puncture and femoral artery PICCO catheter insertion were performed in all patients. PICCO monitoring was carried out. Before low dose capacity loading, HRT MAPP, CVP, PICCO, VV and EVLWI were measured to be T0. After fast infusion of 100ml 0.9% sodium chloride solution through the central venous catheter within one minute, the above indexes were measured again as T1. After 30 minutes of measurement, 500 ml 0.9% sodium chloride solution was infused within 30 minutes, and the above indexes were measured again as T2. The average value of each index was taken after 3 consecutive measurements. The volume reactivity was defined as the increase of CO in T2-T0, which was divided into positive group and negative group according to the reactivity of liquid. The increase rate of CO measured by T1-T0 was CO. All patients were measured the extravascular pulmonary water index at T _ 0 T _ 1 T _ 2. Statistical analysis of T _ 2 and T _ 1 compared with T _ 0 results were statistically significant. Co. The sensitivity and specificity of PPV and CVP were analyzed by using the operating characteristic curve (ROC curve). Results 12 cases of positive group and 10 cases of negative group were divided into positive group and negative group according to their reactivity to liquid. The positive group was compared with the negative group. There was no significant difference in general clinical data among the three groups. The area of CO under the ROC curve was 0.85 (P0.05n.2). 95 CI: 0.695-1.005). The best sensitivity was 0.85 and the specificity was 0.70. The best predicted cut-off point was that there was no significant difference between EVLWI and T _ 0 and T _ 2 in T1 phase of CO=0.15.3 low-dose load test. Compared with T0, the EVLWI of T2 was significantly higher than that of T0, and the results were statistically significant. The sensitivity and specificity of CVP in predicting fluid reactivity were best compared with CO under the ROC curve. Conclusion it is safe to use the small dose volume load test of 1: 1 in sepsis patients. Co can be used as a predictor of liquid reactivity in low-dose volume-loading test. The optimum sensitivity is 0.85 and the specificity is 0.70.2 CO. PPV is more sensitive than CVP in predicting fluid reactivity in septic patients.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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