本文選題：每博量變異 + 下腔靜脈直徑　； 參考：《鄭州大學》2017年碩士論文

【摘要】：背景和目的膿毒性休克,膿毒癥的一種亞型,指膿毒癥患者雖然經過足量的液體復蘇后,低血壓仍持續(xù)存在,需要用血管活性藥物維持平均動脈壓大于65mmHg,血清乳酸水平大于2 mmol/L(18 mg/dL)。膿毒性休克是影響人類的主要健康問題,每年全球新增數百萬患者,大約四分之一或更多的患者出現死亡,與多發(fā)性創(chuàng)傷、急性心肌梗塞或中風類似;膿毒癥發(fā)生后及時采取合適的治療方案,極可能影響患者的預后。通過對比脈波指示劑連續(xù)心排血量法(pulse indicator continuous cardiac output,PICCO)監(jiān)測每博量變異度(SVV)和床旁彩色多普勒超聲監(jiān)測下腔靜脈直徑(IVCD)及呼吸變異指數(RVI)評估膿毒性休克患者的容量反應性,以監(jiān)測指導膿毒性休克患者的液體復蘇。方法采用前瞻性隊列對40例控制性機械通氣膿毒性休克患者行PICCO監(jiān)測,記錄補液前后心排血量(CO)、心排指數(CI)、心率(HR)、每搏輸出量變異率(SVV)、平均動脈壓(MAP),并應用床旁超聲記錄補液前后呼氣末下腔靜脈最大直徑(IVCDmax)及吸氣末下腔靜脈最小直徑(IVCD min),以公式RVI=(IVCDmax-IVCDmin)/IVCDmax×100%計算下腔靜脈RVI;20min內給予500ml復方氯化鈉溶液快速靜脈輸注,將補液后△CI≥15%定義為容量有反應組,△CI15%定義為容量無反應組。比較補液前后2組血流動力學參數、SVV、RVI的變化,評估補液后有容量反應性組SVV與RVI,SVV、RVI分別與△CI的相關性,并以受試者工作特征曲線(ROC曲線)分析SVV、RVI的敏感度和特異度。結果40例患者中,24例為容量有反應,16例為容量無反應。補液后SVV、RVI均與△CI呈正相關,SVV和RVI亦存在相關(r=0.859,P0.01),ROCsvv、ROCrvi曲線下面積分別為0.841±0.061、0.858±0.057,統計學無差異,95%可信區(qū)間分別為0.721~0.961和0.746~0.971。SVV對預測容量反應性的診斷閾值為11%(敏感度為83.6%,特異度為81.4%),RVI診斷閾值為26%(敏感度為87.1%,特異度為83.8%)。結論SVV與RVI均能有效評估機械通氣膿毒性休克的容量反應性,且具有很好的相關性,均能監(jiān)測指導上述患者的液體復蘇。
[Abstract]:Background and objective septic shock, a subtype of sepsis, refers to the persistence of hypotension in patients with sepsis after adequate fluid resuscitation. Vasoactive drugs were required to maintain mean arterial pressure over 65mmHg and serum lactate levels greater than 2 mmol / L ~ (18) mg / d ~ (-1). Septic shock is a major health problem affecting humans, with millions of new patients worldwide each year, with about 1/4 or more dying, similar to multiple trauma, acute myocardial infarction or stroke; Timely treatment of sepsis may affect the prognosis of patients. The volume reactivity of septic shock patients was evaluated by comparing pulse indicator continuous cardiac output PICCO-pulse indicator continuous cardiac output with pulse indicator continuous cardiac output PICCO-pulse indicator continuous cardiac output (PICCO), inferior vena cava diameter (IVCDD) and respiratory variation index (RVI) monitored by color Doppler echocardiography (CDI) in patients with septic shock. Monitor and guide fluid resuscitation in septic shock patients. Methods 40 patients with septic shock undergoing controlled mechanical ventilation were monitored by PICCO in a prospective cohort. Before and after resuscitation, the cardiac output volume, cardiac output index, heart rate and HRV were recorded. The rate of variation per stroke output was estimated to be SVV, and the mean arterial pressure MAPP was measured by bedside ultrasound. The maximum diameter of IVCDmax. of inferior vena cava before and after infusion was recorded by bedside ultrasound) and the minimum straightness of inferior vena cava at the end of inspiratory period was recorded. The 500ml compound sodium chloride solution was given by the formula RVIX / IVCDminmax 脳 100% in 20 minutes. CI 鈮，

本文編號：1987943