[被动抬腿试验诱导的呼气末二氧化碳分压变化在预测感染性休克机械通气患者液体反应性中的价值]

[The value of changes in end-tidal carbon dioxide pressure induced by passive leg raising test in predicting fluid responsiveness in mechanically ventilated patients with septic shock].

作者信息

Zang Zhi-dong, Yan Jie, Xu Hong-yang, Liang Feng-ming, Yang Ting, Wang Da-peng, Gao Fei

机构信息

Department of Critical Care Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China. Email:

出版信息

Zhonghua Nei Ke Za Zhi. 2013 Aug;52(8):646-50.

PMID:24199878

Abstract

OBJECTIVE

To test whether the changes of partial end-tidal carbon dioxide pressure (PETCO2) during passive leg raising (PLR) predict fluid responsiveness in mechanically ventilated patients with septic shock.

METHODS

Forty-two mechanically ventilated patients with septic shock admitted from January 2012 to November 2012 were prospectively recruited.Hemodynamic parameters monitored by a pulse indicator continuous cardiac output (PiCCO) device and PETCO2 monitored by an expiratory-CO2 device were studied at baseline, after PLR, and after volume expansion. Fluid responsiveness was defined as an increase in cardiac index (CI) of 15% or greater after volume expansion. The correlation between PLR-induced CI change (ΔCIPLR) and PETCO2 (ΔPETCO2-PLR) was analyzed. The value of ΔPETCO2-PLR to predict fluid responsiveness was evaluated by receiver operating characteristic (ROC) curves.

RESULTS

A total of 42 patients were enrolled in this study, of whom, 24 had a CI increase of ≥ 15% after volume expansion (responders). After PLR, CI and PETCO2 were both significantly increased in the response group compared with baseline [(21.4 ± 12.9)% of CI and (9.6 ± 4.7)% of PETCO2, P < 0.05], while no significant changes were observed (P > 0.05) in the non-response group. Both ΔCIPLR and ΔPETCO2-PLR were significantly higher in responder group than in the non-responder group (both P < 0.05). ΔCI and ΔPETCO2 after PLR were strongly correlated (r = 0.64, P < 0.05). In responders after PLR, the area under ROC curve of ΔPETCO2-PLR was 0.900 ± 0.056 (95%CI 0.775-1.000, P < 0.05). An increase of ≥ 5% in ΔPETCO2-PLR predicted fluid responsiveness with a sensitivity of 88.0% and specificity of 88.2%.

CONCLUSIONS

The change of PETCO2 induced by passive leg raising is a non-invasive and easy way to predict fluid responsiveness in mechanically ventilated patients with septic shock.

摘要

目的

检测被动抬腿（PLR）过程中部分呼气末二氧化碳分压（PETCO2）的变化是否可预测感染性休克机械通气患者的液体反应性。

方法

前瞻性纳入2012年1月至2012年11月收治的42例感染性休克机械通气患者。在基线、PLR后及扩容后，研究通过脉搏指示连续心输出量（PiCCO）装置监测的血流动力学参数以及通过呼气末二氧化碳装置监测的PETCO2。液体反应性定义为扩容后心脏指数（CI）增加15%或更多。分析PLR诱导的CI变化（ΔCIPLR）与PETCO2（ΔPETCO2-PLR）之间的相关性。通过受试者工作特征（ROC）曲线评估ΔPETCO2-PLR预测液体反应性的价值。

结果

本研究共纳入42例患者，其中24例扩容后CI增加≥15%（反应者）。PLR后，反应组的CI和PETCO2均较基线显著增加[CI增加(21.4±12.9)%，PETCO2增加(9.6±4.7)%，P<0.05]，而非反应组未观察到显著变化（P>0.05）。反应组的ΔCIPLR和ΔPETCO2-PLR均显著高于非反应组（均P<0.05）。PLR后的ΔCI与ΔPETCO2密切相关（r=0.64，P<0.05）。在PLR后的反应者中，ΔPETCO2-PLR的ROC曲线下面积为0.900±0.056（95%CI 0.775-1.000，P<0.05）。ΔPETCO2-PLR增加≥5%预测液体反应性的敏感性为88.0%，特异性为88.2%。