Value of Inferior Vena Cava Respiratory Variation in Assessing Volume Responsiveness in Patients with Septic Shock
-
摘要:
目的 探讨下腔静脉变异度在脓毒性休克患者容量评估中的价值。 方法 选取2018年8月至2019年5月某医科大学第一附属医院急诊科60例脓毒性休克患者，根据液体复苏指导方式不同分为下腔静脉变异度（variance of inferior vena cava，VIVC）指导患者液体复苏A组；中心静脉压（central venous pressure，CVP）指导患者液体复苏B组。分别用超声评估2组患者补液前、后30 min、1 h、3 h、6 h的每搏量（stroke volume，SV）；同时，2组患者在上述时间点记录乳酸值（lactate ，Lac）、B型钠尿肽（brain natriuretic peptide，BNP）、碱剩余（base excess，BE）、心率（heart rate，HR）、呼吸频率（respiratory rate，RR）、中心静脉血氧饱和度（central venous oxygen saturation，SCVO2）、平均动脉压（mean arterial pressure，MAP）、尿量并进行比较。 结果 2组患者随着补液的进行，同组患者不同时间点MAP较治疗前升高，RR明显下降，SCVO2升高、尿量增多（P < 0.05）；但2组间MAP、RR、SCVO2及尿量的变化差异无统计学意义（P > 0.05）；停止复苏后，2组患者BNP较前升高、HR较前下降，B组BNP、HR较A组高（P < 0.05）；2组Lac较前下降，BE较前升高，组间差异无统计学意义（P > 0.05）。 结论 与CVP相比，下腔静脉变异度评估脓毒性休克患者容量反应性同样有价值，且因为更少引起BNP升高，能够避免液体过负荷而更安全。 Abstract:Objective To explore inferior vena cava respiratory variation assessing volume responsiveness in patients with septic shock. Methods A total of 60 patients with septic shock in the Emergency Department of the First Affiliated hospital of a medical university from August 2018 to May 2019 were selected. According to the different guidance methods of fluid resuscitation, they were divided into the Variance of Inferior Vena Cava （VIVC） guided fluid resuscitation group A and Central Venous Pressure （CVP） guided fluid resuscitation in group B. Stroke volume （SV） was evaluated by ultrasound before and 30min, 1h, 3h and 6h after fluid infusion. Lactate （Lac）, brain natriuretic peptide （BNP）, base excess （BE） and heart rate （HR） , respiratory rate （RR）, central venous oxygen saturation （SCVO2）, mean arterial pressure （ MAP） and urine volume were recorded at the above time points in both groups and were compared. Results MAP, SCVO2, and urine volume increased, while RR decreased in the same group at different time points with the progress of fluid infusion （P < 0.05）. However, there was no significant difference in MAP, RR, SCVO2 and urine volume between the two groups （P > 0.05）. After stopping resuscitation, BNP increased and HR decreased in the two groups, and BNP and HR in group B were higher than those in group A （P < 0.05）. Lac decreased and BE increased in the two groups, but there was no significant difference between the two groups （P > 0.05）. Conclusion Compared with CVP, IVC variability is equally valuable in evaluating fluid responsiveness in patients with septic shock, and it is safer because it causes less BNP elevation and avoids fluid overload. -
表 1 2组患者基本情况比较（
$ \bar x \pm s $ ）Table 1. Baseline Participant Characteristics （
$ \bar x \pm s $ ）指标 A组 B组 χ2/t P 年龄（岁） 63.23 ± 5.56 65.77 ± 5.73 −1.739 0.087 性别 0.069 0.793 男性 17 18 女性 13 12 APECHEII评分（分） 23.97 ± 2.28 22.57 ± 2.05 0.715 0.478 
下载: 导出CSV
表 2 2组患者不同时间点SV、MAP、RR、SCVO2、尿量比较（
$ \bar x \pm s $ ）Table 2. Comparison of SV，MAP，RR，SCVO2，urine volume for two group at different time （
$ \bar x \pm s $ ）指标 0 min 30 min 1 h 3 h 6 h F P SV（mL） A组 53.60 ± 4.17 59.18 ± 2.81 61.50 ± 3.54 63.85 ± 3.45 62.32 ± 5.63 0.274 0.603 B组 52.69 ± 3.84 59.19 ± 2.87 61.22 ± 3.39 64.85 ± 4.16 63.75 ± 6.35 71.200 < 0.001* MAP（mmHg） A组 55.70 ± 3.24 58.18 ± 3.75 61.09 ± 3.80 63.20 ± 5.43 69.33 ± 7.48 0.007 0.933 B组 56.09 ± 4.44 58.66 ± 3.37 60.59 ± 3.80 62.75 ± 4.72 69.19 ± 5.80 50.446 < 0.001* RR（次/min） A组 34.52 ± 4.70 30.81 ± 3.91 29.54 ± 3.66 25.82 ± 3.80 22.12 ± 2.22 1.880 0.176 B组 30.64 ± 3.57 30.69 ± 4.30 27.41 ± 3.43 27.40 ± 3.80 23.35 ± 2.30 71.361 < 0.001* SCVO2（%） A组 64.58 ± 3.78 67.66 ± 2.84 70.47 ± 4.82 73.04 ± 3.86 78.34 ± 5.02 0.275 0.602 B组 65.39 ± 4.27 68.55 ± 3.57 70.27 ± 5.99 71.84 ± 4.40 76.72 ± 4.43 69.548 < 0.001* 尿量（mL/h） A组 19.29 ± 5.97 21.54 ± 4.60 26.38 ± 4.79 29.99 ± 4.42 38.89 ± 3.19 0.177 0.676 B组 21.99 ± 7.00 22.80 ± 4.37 24.28 ± 6.06 29.91 ± 5.33 38.31 ± 4.22 196.915 < 0.001* *P < 0.05。
下载: 导出CSV
表 3 2组患者补液结束后情况比较（
$ \bar x \pm s $ ）Table 3. Comparison after fluid resuscitation （
$ \bar x \pm s $ ）指标 A组 B组 t P Lac（mmol/L） 3.12 ± 0.78 3.53 ± 1.29 −1.512 0.137 BNP（pg/ml） 254.71 ± 141.74 363.93 ± 125.44 −3.161 0.003* BE（mmol/L）
HR（次/min）−3.26 ± 1.11
83.59 ± 11.30−3.91 ± 1.76
95.30 ± 9.391.706
−4.3670.094
< 0.001**P < 0.05。
下载: 导出CSV
-
[1] Singer M, Deutschman C S, Seymour C W, et al. The third international consensus definitions for sepsis and septic shock （Sepsis-3） [J]. JAMA, 315（8）: 801-810. [2] Monnet X, Lai C, Teboul J L. How I personalize fluid therapy in septic shock?[J] Crit Care, 2023 , 27（1）: 123. [3] Casserly B,Read R,Levy M M. Hemodynamic monitoring in sepsis[J]. Crit Care Clin,2009,25(4):803-823. doi: 10.1016/j.ccc.2009.08.006 [4] Marik P E,Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some commonsense[J]. Crit Care Med,2013,41(7):1774-1781. doi: 10.1097/CCM.0b013e31828a25fd [5] Chong Y,Yu Y,Zhao Y,et al. Value of inferior vena cava diameter and inferior vena cava collapse index in the evaluation of peripartum volume: A prospective cohort study[J]. Eur J Obstet Gynecol Reprod Bio,2023,285:69-73. [6] Singer M,Deutschman C S,Seymour C W,et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J]. JAMA,2016,315(8):801-810. [7] Rivers E P,Kruse J A,Jacobsen G,et al. The influence of early hemodynamic optimization on biomarker patterns of severe sepsis and septic shock[J]. Crit Care Med,2007,35(9):2016-2024. doi: 10.1097/01.CCM.0000281637.08984.6E [8] Zhao J,Wang G. Inferior vena cava collapsibility index is a valuable and non-invasive index for elevated general heart end-diastolic volume index estimation in septic shock patients[J]. Med Sci Monit,2016,22:3843-3848. doi: 10.12659/MSM.897406 [9] De Valk S,Olgers T J,Holman M,et al. The caval index:An adequate non-invasive ultrasound parameter to predict fluid responsiveness in the emergency department?[J]. BMC Anesthesiol,2014,4:114. [10] Kim D W,Chung S,Kang W S,et al. Diagnostic accuracy of ultrasonographic respiratory variation in the Inferior vena cava,subclavian vein,internal jugular vein,and femoral vein diameter to predict fluid responsiveness: A systematic review and meta-analysis[J]. Diagnostics (Basel),2021,12(1):49. doi: 10.3390/diagnostics12010049 [11] Xiong Z,Zhang G,Zhou Q,et al. Predictive value of the respiratory variation in inferior vena cava diameter for ventilated children with septic shock[J]. Front Pediatr,2022,10:895651. [12] 王君生. PICCO和超声评估脓毒性休克容量反应性的研究[D]. 郑州: 郑州大学, 2017. [13] 黄伟,万献尧. 2013版严重全身性感染和感染性休克处理指南解读[J]. 中国实用内科杂志,2013,33(11):866-868. [14] Osman D,Ridel C,Ray P,et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge[J]. Crit Care Med,2007,35(1):64-68. doi: 10.1097/01.CCM.0000249851.94101.4F [15] Cecconi M,De Backer D,Antonelli M,et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine[J]. Intensive Care Med,2014,40(12):1795-1815. doi: 10.1007/s00134-014-3525-z [16] Marik P E,Baram M,Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares[J]. Chest,2008,134(1):172-178. doi: 10.1378/chest.07-2331 -
点击查看大图
图(1) / 表(3)
计量
- 文章访问数: 1529
- HTML全文浏览量: 1272
- PDF下载量: 1
- 被引次数: 0
