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目的 探讨被动抬腿试验联合上肢抬高(PLR combined with upper limb elevation,uPLR)是否提高预测感染性休克病患者容量反应性的准确性.方法 2014年10月-2017年10月入住徐州市第一医院重症医学科19例感染性休克患者纳入研究.采用脉搏指示连续心输出量及呼气二氧化碳监测技术监测被动抬腿试验(Passive leg raising,PLR)、uPLR和液体负荷试验前后患者每搏量(Stroke volume,SV)、脉压(pulse pressure,PP)、呼气二氧化碳容积(carbon dioxide of elimination of per breath,VTCO2br)和呼气末二氧化碳分压(end tidal carbon dioxide partial pressure,PETCO2)的变化情况,容量负荷试验后SV增加值(△SV)≥10%定义为容量反应阳性.采用ROC曲线分析PLR和uPLR预测容量反应性的准确性.结果 19例患者行53次容量负荷试验,其中24次容量反应阳性(阳性组)、29次容量反应阴性(阴性组).PLR和uPLR试验后,阳性组患者SV、PP 、PETCO2和VTCO2br均显著增加,且uPLR试验后SV和VTCO2br显著高于PLR试验,分别是(81±22)mL比(77±19)mL和(27.1±6.1)mL比(25.2±6.2)mL,差异均有统计学意义(P 0.05);PLR和uPLR后,△SV和△VTCO2br与补液后△SV成高度正相关(P <0.001).PLR和uPLR试验后△SV、△PP、△VTCO2br和△PETCO2预测容量反应性ROC曲线下面积分别为0.92、0.85、0.86、0.77和0.94、0.84、0.87和0.77,灵敏度分别是83.30% 、75.00% 、79.16% 、70.83%和87.50% 、75.00% 、83.33% 、75.00% ,特异度分别为89.65%、82.75%、86.20%、79.31%和93.10%、86.20%、89.65%、79.31%.结论 uPLR试验可以提高预测容量反应的敏感性和特异性,△SV、△PP、△VTCO2br和△PETCO2等四项指标中△SV预测效果最好,“,”To explore whether the accuracy of predicting volume responsiveness can be improved by passive leg raising combined with upper limb elevation (uPLR) in patients with septic shock. Methods Nineteen septic shock patients in intensive care unit of Xuzhou No.1 Hospital from October 2014 to October 2017were were enrolled in the study. Stoke volume(SV), pulse pressure(PP), expiratory carbon dioxide volume (VTCO2br) and end-expiratory carbon dioxide partial pressure (PETCO2) were measured by pulse indicator continuous cardiac output and expiratory carbon dioxide monitoring at baseline, before and after PLR, uPLR and liquid load test. The PLR and uPLR tests with Δ SV ≥ 10% after liquid load were defined as positive of volumetric responsiveness. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy of PLR and uPLR in predicting volume responsiveness. Results 53 instances of volumetric load tests were performed in 19 patients with septic shock, among which volume responsiveness of 24 instances were positive (positive group), 29 instances being negative (negative group). SV, PP, PETCO2 and VTCO2br after PLR and uPLR test increased significantly in positive group, and SV and VTCO2br in uPLR test were significantly higher than that in PLR test (81±22ml vs 77±19ml and 27.1±6.1ml vs 25.2±6.2 ml, respectively), the difference was statistically significant, while in the negative group there was no significant difference of the above indexes before and after PLR and uPLR test. △SV and △VTCO2br, after PLR and uPLR test, were positively correlated with△SV after liquid load. After PLR and uPLR test, the area under ROC curve of△SV,△PP,△VTCO2br and △PETCO2 was 0.92, 0.85, 0.86, 0.77 and 0.94, 0.84, 0.87 and 0.77 respectively, the sensitivity was 83.30% , 75.0% , 79.16% , 70.83% and 87.50% , 75.00% , 83.33% , 75.00% respectively, and the specificity was respectively 89.65%, 82.75%, 86.20%, 79.31% and 93.10%, 86.20%, 89.65%, 79.31%. of the four. Conclusion The sensitivity and specificity of predicting volume responsiveness can be improved by passive leg raising combined with upper limb elevation in septic shock patients. Among the four parameters of△SV,△PP,△VTCO2br and△PETCO2,△SV was the best predictor.