Huang Lei, Zhang Wei-xing, Cai Wen-xun, Zhu Zhong-sheng, Zhang Chi, Jiang Chun-ling
Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 Mar;23(3):154-7.
To evaluate the role of passive leg raising (PLR) test in predicting volume responsiveness in severe sepsis and septic shock patients.
Thirty severe sepsis and septic shock patients in intensive care unit (ICU) of Peking University Shenzhen Hospital were prospectively observed from February 2009 to January 2010. The hemodynamics including stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) were measured non invasively by ultrasonic cardiac output monitor (USCOM) device in the supine position, during PLR and after volume expansion (VE), and invasive arterial blood pressure and central venous pressure (CVP) were monitored consecutively. Responders were defined by the appearance of an increase in SV (ΔSV) ≥ 15% after VE. The role of PLR for predicting volume responsiveness was evaluated by receiver operating characteristic (ROC) curves.
The CVP (cm H(2)O, 1 cm H(2)O=0.098 kPa) during PLR was increased compared with that at supine position in both responder group ( n =15) and non responder group ( n =15, 13.6 ± 6.6 vs. 12.1 ± 6.0, 11.9 ± 5.5 vs. 10.8 ± 5.2 , both P <0.01). ΔSV was higher in responder group than in non responder group during PLR [(16.6 ± 5.5)% vs. (3.8 ± 8.2)%, P=0.000].ΔSV during PLR was highly correlated to ΔSV after VE (r =0.681 , P =0.000).The area under the ROC curve (AUC) for PLR predicting volume responsiveness was 0.944 ± 0.039 ( P =0.000). The ΔSV>11% during PLR was found to predict volume responsiveness with a sensitivity of 86.7%, specificity of 93.3%, positive predictive value of 92.9% and negative predictive value of 87.5%.
PLR can be used generally to predict volume responsiveness accurately in severe sepsis and septic shock patients, and it can be used to direct clinical practice.
评估被动抬腿（PLR）试验在预测严重脓毒症和脓毒性休克患者容量反应性中的作用。
对2009年2月至2010年1月北京大学深圳医院重症监护病房（ICU）的30例严重脓毒症和脓毒性休克患者进行前瞻性观察。采用超声心输出量监测仪（USCOM）在仰卧位、PLR期间及容量扩充（VE）后无创测量包括每搏输出量（SV）、心输出量（CO）和全身血管阻力（SVR）在内的血流动力学指标，并连续监测有创动脉血压和中心静脉压（CVP）。以VE后SV增加（ΔSV）≥15%定义为反应者。通过受试者工作特征（ROC）曲线评估PLR预测容量反应性的作用。
反应者组（n = 15）和非反应者组（n = 15）在PLR期间的CVP（cm H₂O，1 cm H₂O = 0.098 kPa）均高于仰卧位时（反应者组：13.6±6.6 vs. 12.1±6.0；非反应者组：11.9±5.5 vs. 10.8±5.2，均P < 0.01）。PLR期间反应者组的ΔSV高于非反应者组[（16.6±5.5）% vs.（3.8±8.2）%，P = 0.000]。PLR期间的ΔSV与VE后的ΔSV高度相关（r = 0.681，P = 0.000）。PLR预测容量反应性的ROC曲线下面积（AUC）为0.944±0.039（P = 0.000）。发现PLR期间ΔSV>11%预测容量反应性的敏感度为86.7%，特异度为93.3%，阳性预测值为92.9%，阴性预测值为87.5%。
PLR可普遍用于准确预测严重脓毒症和脓毒性休克患者的容量反应性，并可指导临床实践。
