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目的分析脓毒症休克患者PiCCO监测下液体复苏中的胸腔内血容量指数(ITBVI)与中心静脉压(CVP)的相关性。方法对50例脓毒症休克患者严格按照2008年脓毒症救治指南进行液体复苏,测定记录的ITBVI与其对应的CVP值,观察不同CVP范围值的容量反应准确性。结果脓毒症休克患者容量监测全过程中,CVP与ITBVI无相关性(r=-0.016,P>0.05),CVP在0～8 mmHg或>12 mmHg时,与ITBVI无相关性(r分别为-0.201、-0.009,P>0.05),当达到脓毒症指南复苏目标时(CVP 8～12 mmHg),与ITBVI呈正相关(r=0.542,P<0.01)。结论在脓毒症休克患者中,因其病理生理的特殊性,且受多方面因素影响,如胸腔内压、腹腔内压等,CVP不适合单独作为液体复苏容量的参考指标。
Objective To analyze the relationship between the intrathoracic blood volume index (ITBVI) and central venous pressure (CVP) in fluid resuscitation under PiCCO in septic shock patients. Methods Fifty patients with septic shock were treated with liquid resuscitation in strict accordance with the guidelines for sepsis in 2008. The recorded ITBVI and its corresponding CVP value were measured and the volume response accuracy of different CVP range values was observed. Results There was no correlation between CVP and ITBVI (r = -0.016, P> 0.05) and CVP at 0 ~ 8 mmHg or> 12 mmHg in patients with septic shock -0.201, -0.009, P> 0.05). When the goal of sepsis recovery was reached (CVP 8-12 mmHg), there was a positive correlation with ITBVI (r = 0.542, P <0.01). Conclusions In patients with septic shock, CVP is not suitable as a reference index for fluid resuscitation alone due to its particular pathophysiology and various factors such as intrathoracic pressure and intra-abdominal pressure.