Lu Guo-ping, Yan Gangfeng, Chen Yang, Lu Zhu-jin, Zhang Lin-en, Kissoon Niranjan
Division of Pediatric Emergency Medicine and Critical Care Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China.
Indian J Pediatr. 2015 Jan;82(1):5-12. doi: 10.1007/s12098-013-1303-5. Epub 2013 Dec 11.
To assess whether the passive leg raising (PLR) test can predict fluid responsiveness in pediatric patients.
This was a prospective observational study in a tertiary care pediatric center. Hemodynamic parameters including heart rate, stroke volume and cardiac output were assessed at baseline, after passive leg raising (PLR), at second baseline, and after volume loading (10 mL/kg normal saline in 10 min). Cutoff values of 7.5 and 10 % increase in cardiac index (CI) with passive leg raising were explored as predictors of volume loading response.
Overall, the changes in CI with passive leg raising varied widely and was a poor predictor of response to volume loading in children under 5 years of age. Of 40 patients, 23 had greater than 10 % increase in CI with PLR which predicted fluid responsiveness with a sensitivity of 94 % (95 % confidence interval 71,100) and specificity of 26 % (95 % confidence interval 10,48). Sensitivity was higher (100 % vs. 91 %) and specificity similar (27 % vs. 25 %) in predicting CI for those over 5 as compared to under 5 y, respectively. In patients over 5 y, simple linear regression revealed a positive correlation (R(2) = 21) while R(2) values were much lower (0-0.07) for those under 5 y.
Cardiac index changes after PLR varies widely in children and may be a poor predictor to volume loading in children under 5-y-old. However, in those over 5 y, PLR may be helpful in predicting fluid responsiveness in pediatric patients.
评估被动抬腿（PLR）试验能否预测儿科患者的液体反应性。
这是一项在三级医疗儿科中心进行的前瞻性观察研究。在基线、被动抬腿后、第二次基线以及容量负荷后（10分钟内输注10 mL/kg生理盐水）评估包括心率、每搏量和心输出量在内的血流动力学参数。探讨被动抬腿时心脏指数（CI）增加7.5%和10%的临界值作为容量负荷反应的预测指标。
总体而言，被动抬腿时CI的变化差异很大，对于5岁以下儿童，它是容量负荷反应的不良预测指标。40例患者中，23例被动抬腿时CI增加超过10%，其预测液体反应性的敏感性为94%（95%置信区间71,100），特异性为26%（95%置信区间10,48）。与5岁以下儿童相比，5岁及以上儿童预测CI时的敏感性更高（分别为100%对91%），特异性相似（分别为27%对25%）。在5岁及以上患者中，简单线性回归显示呈正相关（R(2)=21），而5岁以下患者的R(2)值要低得多（0 - 0.07）。
被动抬腿后心脏指数变化在儿童中差异很大，对于5岁以下儿童可能是容量负荷的不良预测指标。然而，对于5岁及以上儿童，被动抬腿可能有助于预测儿科患者的液体反应性。
