脓毒症致急性循环衰竭患者动脉脉压呼吸变化与液体反应性的关系
Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure.
作者信息
Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky M R, Teboul J L
机构信息
Service de Réanimation Médicale et Service de Physiologie Cardio-Respiratoire, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre, Université Paris XI, Paris, France.
出版信息
Am J Respir Crit Care Med. 2000 Jul;162(1):134-8. doi: 10.1164/ajrccm.162.1.9903035.
In mechanically ventilated patients with acute circulatory failure related to sepsis, we investigated whether the respiratory changes in arterial pressure could be related to the effects of volume expansion (VE) on cardiac index (CI). Forty patients instrumented with indwelling systemic and pulmonary artery catheters were studied before and after VE. Maximal and minimal values of pulse pressure (Pp(max) and Pp(min)) and systolic pressure (Ps(max) and Ps(min)) were determined over one respiratory cycle. The respiratory changes in pulse pressure (DeltaPp) were calculated as the difference between Pp(max) and Pp(min) divided by the mean of the two values and were expressed as a percentage. The respiratory changes in systolic pressure (DeltaPs) were calculated using a similar formula. The VE-induced increase in CI was >/= 15% in 16 patients (responders) and < 15% in 24 patients (nonresponders). Before VE, DeltaPp (24 +/- 9 versus 7 +/- 3%, p < 0.001) and DeltaPs (15 +/- 5 versus 6 +/- 3%, p < 0.001) were higher in responders than in nonresponders. Receiver operating characteristic (ROC) curves analysis showed that DeltaPp was a more accurate indicator of fluid responsiveness than DeltaPs. Before VE, a DeltaPp value of 13% allowed discrimination between responders and nonresponders with a sensitivity of 94% and a specificity of 96%. VE-induced changes in CI closely correlated with DeltaPp before volume expansion (r(2) = 0. 85, p < 0.001). VE decreased DeltaPp from 14 +/- 10 to 7 +/- 5% (p < 0.001) and VE-induced changes in DeltaPp correlated with VE-induced changes in CI (r(2) = 0.72, p < 0.001). It was concluded that in mechanically ventilated patients with acute circulatory failure related to sepsis, analysis of DeltaPp is a simple method for predicting and assessing the hemodynamic effects of VE, and that DeltaPp is a more reliable indicator of fluid responsiveness than DeltaPs.
在因脓毒症导致急性循环衰竭的机械通气患者中，我们研究了动脉压的呼吸变化是否与容量扩充（VE）对心脏指数（CI）的影响有关。对40例留置体循环和肺动脉导管的患者在容量扩充前后进行了研究。在一个呼吸周期内测定脉压（Pp(max)和Pp(min)）以及收缩压（Ps(max)和Ps(min)）的最大值和最小值。脉压的呼吸变化（DeltaPp）计算为Pp(max)与Pp(min)之差除以两者的平均值，并以百分比表示。收缩压的呼吸变化（DeltaPs）使用类似公式计算。容量扩充使16例患者（反应者）的CI增加≥15%，24例患者（无反应者）的CI增加<15%。在容量扩充前，反应者的DeltaPp（24±9%对7±3%，p<0.001）和DeltaPs（15±5%对6±3%，p<0.001）高于无反应者。受试者工作特征（ROC）曲线分析表明，DeltaPp比DeltaPs更准确地反映液体反应性。在容量扩充前，DeltaPp值为13%时可区分反应者和无反应者，敏感性为94%，特异性为96%。容量扩充前CI的变化与DeltaPp密切相关（r(2)=0.85，p<0.001）。容量扩充使DeltaPp从14±10%降至7±5%（p<0.001），容量扩充引起的DeltaPp变化与容量扩充引起的CI变化相关（r(2)=0.72，p<0.001）。得出的结论是，在因脓毒症导致急性循环衰竭的机械通气患者中，分析DeltaPp是预测和评估容量扩充血流动力学效应的一种简单方法，并且DeltaPp比DeltaPs更可靠地反映液体反应性。
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