FloTrac/Vigileo系统与超声在评估脓毒症休克血流动力学相关性及对比研究OA
Correlation and Comparative Study of FloTrac/Vigileo System and Ultrasound in Assessing Hemodynamics in Septic Shock
目的 对比超声与FloTrac/Vigileo系统对脓毒症休克患者液体复苏有效性的评估效果.方法 研究选取 2023 年 1 月-2024 年 8 月我院重症医学科 80 例需机械通气的脓毒症休克患者,先进行早期集束化治疗,再用超声与FloTrac/Vigileo系统测量容量指标,通过容量负荷试验(VE)评估容量反应性,根据心脏每搏量增加(△SV)≥15%为有反应组,△SV＜15%为无反应组,其中有反应组 38 例,无反应组 42 例.对比两组在VE前,超声与FloTrac/Vigileo系统测量的相关参数数值,分析这些参数与△SV的相关性,以及它们对容量反应特性的预测价值.结果 VE前,有反应组的中心静脉压(CVP)、下腔静脉直径(IVC-D)低于无反应组,而下腔静脉膨胀指数(dIVC)、每搏量变异度(SVV)、抬腿试验前后每搏量变异度(△SV-PLR)则大于无反应组,具有统计学差异(P＜0.05).根据相关性分析,VE前的CVP、IVC-D、dIVC、SVV、△SV-PLR与△SV均呈直线关系(r值分别为-0.367、-0.630、0.788、0.936、0.942,均P＜0.05),其中△SV-PLR的相关性最高;ROC曲线分析显示,VE前的CVP、IVC-D、dIVC、SVV、△SV-PLR在估计容量反应性的ROC曲线下面积(AUC)依次为 0.404、0.160、0.683、0.829、0.860,以△SV-PLR的预测价值最高,而CVP、IVC-D无预测价值.结论 脓毒症休克机械通气的患者,超声监测dIVC及FloTrac/Vigileo系统监测SVV、△SV-PLR均能对机械通气脓毒症休克患者的容量反应性有效预测,但以△SV-PLR的特异度和敏感度最佳.
Objective To compare the effectiveness of ultrasound and the FloTrac/Vigileo system in evaluating fluid resuscitation in patients with septic shock.Methods From January 2023 to August 2024,80 patients with septic shock requiring mechanical ventilation admitted to the Intensive Care Vnit of our hospital were enrolled.All patients received early goal-directed therapy,followed by volume status measurements using ultrasound and the FloTrac/Vigileo system.Volume responsiveness was assessed by volume expansion(VE).Patients were divided into two groups based on stroke volume increase(△SV):the response group(△SV≥15%,n=38)and the non-response group(△SV＜15%,n=42).The parameters measured by ultrasound and the FloTrac/Vigileo system before VE were compared between the two groups.The correlations between these parameters and △SV were analyzed,and their predictive value for volume responsiveness was evaluated.Results Before VE,the central venous pressure(CVP)and inferior vena cava diameter(IVC-D)of the response group were lower than those of the non-response group,while the distensibility index of the inferior vena cava(dIVC),stroke volume variation(SVV),stroke volume variation before and after leg raising test(△SV-PLR)were higher than those of the non-response group,and the differences were statistically significant(P＜0.05).According to correlation analysis,CVP,IVC-D,dIVC,SVV,△SV-PLR before VE were linearly correlated with △SV(r values were-0.367,-0.630,0.788,0.936,0.942,all P＜0.05),and △SV-PLR had the highest correlation;ROC curve analysis showed that the area under the ROC curve(AUC)of CVP,IVC-D,dIVC,SVV,and △SV-PLR before VE were 0.404,0.160,0.683,0.829,and 0.860,and △SV-PLR had the highest predictive value,while CVP and IVC-D had no predictive value.Conclusion In patients with mechanical ventilation for septic shock,ultrasonic monitoring of dIVC and FloTrac/Vigileo system monitoring of SVV and △SV-PLR can effectively predict the fluid responsiveness of patients with mechanical ventilation septic shock,but △SV-PLR has the best specificity and sensitivity.
娄侠儒;王维策;黄响玲;隋鑫;张莉
佛山复星禅诚医院 重症医学科,广东 佛山 528031佛山复星禅诚医院 超声科,广东 佛山 528031佛山复星禅诚医院 重症医学科,广东 佛山 528031佛山复星禅诚医院 重症医学科,广东 佛山 528031佛山复星禅诚医院 重症医学科,广东 佛山 528031
医药卫生
脓毒症休克容量反应性FloTrac/Vigileo系统重症超声下腔静脉抬腿试验
Septic shockFluid responsivenessFloTrac/Vigileo systemsSevere ultrasoundInferior vena cavaPassive leg raise test
《医学信息》 2026 (10)
47-51,56,6
1.2023年度佛山市卫生健康局医学科研课题(编号:20230423)2.佛山市"十四五"医学培育专科项目(佛卫函[2021]107号)
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