| 杨娜,谢永鹏,刘克喜.颈动脉校正血流时间及颈动脉峰流速变异度预测感染性休克病人容量反应性的研究[J].安徽医药,2021,25(12):2416-2420. |
| 颈动脉校正血流时间及颈动脉峰流速变异度预测感染性休克病人容量反应性的研究 |
| A study of carotid artery correction flow time and carotid peak flow variability in predicting volume responsiveness in septic shock patients |
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| DOI：10.3969/j.issn.1009-6469.2021.12.020 |
| 中文关键词: 休克，脓毒性 每搏输出量 颈动脉校正血流时间 颈动脉峰流速变异度 容量反应性 超声心动描记术，多普勒，彩色 |
| 英文关键词: Shock, septic Stroke volume Carotid artery correction blood flow time Carotid peak velocity variability Vol. ume reactivity Echocardiography, Doppler, color |
| 基金项目:江苏省卫健委面上项目课题( H2019109) |
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| 中文摘要: |
| 目的探讨颈动脉校正血流时间( FTc)、颈动脉峰流速变异度( ΔVpeak-CA)对感染性休克的自主呼吸病人容量反应性的预测价值。方法采用前瞻性研究方法，选取 2019年 1月至 2020年 5月徐州医科大学附属连云港医院收治的感染性休克的自主呼吸病人 57例，经胸心脏超声( TTE)监测容量负荷试验( VE)前后每搏输出量( SV)的变化，以 VE后每搏出量增加值(ΔSV-VE)≥15%定义为容量有反应组，反之定义为无反应组。记录 VE前后各项血流动力学参数:平均动脉压( MAP)、中心静脉压( CVP)、心率、 FTc、ΔVpeak-CA，采用 Pearson相关分析并绘制受试者工作特征曲线( ROC曲线)，分析 FTc及各 ΔVpeak-CA对容量反应性的预测价值。结果研究期间 6例在试验过程中因颈动脉狭窄、反复出现心律失常而被排除，最终共 51例纳入分析，有反应组 24例，无反应组 27例。 VE前，有反应组病人颈动脉 FTc明显低于无反应组［( 332.42±31.14)ms比( 375.08±42.24)ms］ΔVpeak-CA明显高于无反应组［(13.30±4.77)%比(8.16±4.31)%］(均 P<0.05)，VE后两组颈动脉 FTc、ΔVpeak-CA差异无统计学意，义( P>0.05)。 VE前颈动脉 FTc与 ΔSV-VE呈高度负相关， r=.0.721；ΔVpeak-CA与 ΔSV-VE呈正相关， r=0.700，均 P<0.05。ROC曲线分析显示:颈动脉 FTc、ΔVpeak-CA预测容量反应性的 ROC曲线下面积( AUC)分别为 0.830(95%CI:0.701~0.959)、 0.810(95%CI:0.685~0.936)颈动脉 FTc预测容量反应性的最佳临界值为 349.83 ms时，灵敏度为 85.2%，特异度为 87.5%；ΔVpeak-CA最佳临界值为 9.90灵敏度为 79.2%，特异度为 81.5%。结论超声监测颈动脉 FTc、ΔVpeak-CA均能较好地预测感染性休克病人的容量反应性，以 FTc的特异度和灵敏度最佳。 |
| 英文摘要: |
| Objective To investigate the predictive value of carotid artery corrected blood flow time (FTc) and variability of carotidpeak flow velocity (ΔVpeak-CA) in volume responsiveness in patients with spontaneous respiration in septic shock.Methods A pro.spective study was conducted on 57 patients with spontaneous respiration in septic shock admitted in the Department of Critical CareMedicine of the Lianyungang Hospital Affliated to Xuzhou Medical University from January 2019 to May 2020. Transthoracic echocar.diography (TTE) was employed to monitor changes of stroke volume (SV) before and after volume expansion test (VE). The increment ofSV (ΔSV-VE) ≥ 15% after the VE test was defined as a volume response group, and vice versa as a non-response group. The hemody.namic parameters were recorded before and after VE including mean arterial pressure (MAP), central venous pressure (CVP), heartrate, FTc, andΔVpeak-CA. Pearson correlation analysis was used and receiver operating characteristic curve (ROC) was plotted to ana.lyze the predictive value of FTc and ΔVpeak-CA to volume responsiveness.Results Six cases were excluded due to carotid artery ste.nosis and recurrent arrhythmia during the study. Consequently, a total of 51 patients were included in the analysis, including 24 pa.tients in the response group and 27 in the non-response group. Before VE, carotid artery FTc in the response group was significantly lower than that in the non-response group, and ΔVpeak-CA was remarkably higher than that in the non-response group [carotid artery FTc: (332.42±31.14) ms vs (375.08 ± 42.24) ms, ΔVpeak-CA: (13.30 ± 4.77)% vs (8.16 ± 4.31)%; both P<0.05]. No significant differ. ence was revealed in carotid artery FTc and ΔVpeak-CA between the two groups after VE (P>0.05). A negative correlation was revealed between carotid artery FTc and ΔSV-VE before VE (r=.0.721, P<0.05), and a positive correlation was revealed between ΔVpeak-CA and ΔSV-VE (r=0.700, P<0.05). ROC curve analysis revealed that the areas under the ROC curve (AUC) predicted by carotid artery FTc and ΔVpeak-CA were 0.830 (95%CI: 0.701-0.959) and 0.810 (95%CI: 0.685-0.936), respectively. When the optimal critical valueof carotid artery FTc for predicting volume responsiveness was 349.83 ms, the sensitivity was 85.2% and specificity was 87.5%. Whenthe optimal critical value of ΔVpeak-CA was 9.90%, the sensitivity was 79.2%, and the specificity was 81.5%.Conclusion Ultrasonic monitoring of both carotid artery FTc and ΔVpeak-CA could predict the volume responsiveness of patients with septic shock, and carot.id artery FTc presents better specificity and sensitivity. |
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