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目的探讨脓毒性休克机械通气患者进行液体复苏治疗时每搏变异度(SVV)对容量反应性的预测价值。方法选取重症医学科于2014年8月至2015年8月收治的脓毒性休克行机械通气治疗患者50例作为研究对象。所有患者在有液体复苏指征时予500 ml复方氯化钠快速静脉输注行液体复苏治疗,对所有患者于液体复苏前后均行脉博指示连续排出量(Pi CCO)、中心静脉压(CVP)监测,并行经肺热稀释测量,记录心排指数(CI)、心输出量(CO)、平均动脉压(MAP)、SVV、CVP监测。依据液体复苏前后容量反应性指标CI增加率(△CI)进行分组,将△CI≥15%的患者作为有反应组,共28例;将△CI<15%的患者作为无反应组,共22例。分别对SVV、CVP和△CI进行相关性分析。结果液体复苏前,有反应组CI、SVV、心率、MAP、CO均差于无反应组,差异有统计学意义(P<0.01,P<0.05);液体复苏后有反应组上述各项指标均有改善,其中CI、SVV、MAP和CO优于无反应组,差异均有统计学意义(P<0.01,P<0.05)。SVV和△CI(r=0.763,P=0.008)、CVP和△CI(r=0.386,P=0.038)分别呈正相关。结论 SVV和CVP在脓毒性休克机械通气患者液体复苏治疗中对容量反应性均具有一定预测价值,因CVP受影响因素较多,临床上SVV的应用价值较高。
Objective To investigate the predictive value of stroke-to-stroke variability (SVV) in volume response to fluid resuscitation in patients with septic shock. Methods Fifty patients with mechanical ventilation of septic shock treated in the Department of Critical Care Medicine from August 2014 to August 2015 were enrolled in this study. All patients underwent liquid resuscitation with 500 ml compound sodium chloride fast venous infusion when liquid resuscitation indications were performed. All patients underwent CPAP (Pi CCO) and central venous pressure (CVP) before and after liquid resuscitation ) Were measured. Hypothermia was measured in parallel. Cardiothoracic index (CI), cardiac output (CO), mean arterial pressure (MAP), SVV and CVP were recorded. According to the increase rate (△ CI) of volume responsive index (CI) before and after liquid resuscitation, patients with △ CI≥15% were treated as response group, a total of 28 patients. Patients with △ CI <15% example. Correlations between SVV, CVP and △ CI were analyzed respectively. Results Before the liquid resuscitation, there was a significant difference in CI, SVV, heart rate, MAP and CO between the reaction group and the non-reaction group (P <0.01, P <0.05) There was improvement in CI, SVV, MAP and CO than non-response group, the difference was statistically significant (P <0.01, P <0.05). SVV and △ CI (r = 0.763, P = 0.008), CVP and △ CI (r = 0.386, P = 0.038) were positively correlated. Conclusions Both SVV and CVP have predictive value on volume responsiveness in fluid resuscitation in patients with septic shock and mechanical ventilation, because there are many influencing factors of CVP and clinical value of SVV is high.