Tong Hongjie, Hu Caibao, Hao Xuejing, Cai Guolong, Rao Qun, Yan Molei, Chen Jin, Yan Jing
Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou 310013, China. Email:
Zhonghua Nei Ke Za Zhi. 2015 Feb;54(2):130-3.
To investigate the value of bioreactance-based passive leg raising (PLR) test predicting fluid responsiveness of elderly patients with sepsis.
This prospective and self-controlled clinical study included 31 elderly patients with sepsis in the Department of Intensive Care Medicine of Zhejiang Hospital. Hemodynamic parameters including cardiac output (CO), stroke volume variation (SVV) were continuously recorded by bioreactance-based device (noninvasive cardiac output monitoring, NICOM) before and after PLR and volume expansion (VE) test. Patients were defined as responders if CO increased ≥ 10% after VE.
A total of 100 PLR and VE tests in these 31 patients were evaluated.In 28 responders, CO[(5.11 ± 2.10) L/min vs (5.91 ± 2.45) L/min, P < 0.05; (5.06 ± 2.06) L/min vs (5.77 ± 2.47) L/min, P < 0.05] and SV [(59.61 ± 18.22) ml vs (69.29 ± 21.32) ml, P < 0.05; (60.10 ± 15.95) ml vs (70.06 ± 17.96) ml, P < 0.05] were obviously increased both after PLR and VE. The ΔCO after PLR (ΔCOPLR) and ΔCOVE was highly correlated (r = 0.819, P = 0.001) while the SVV before VE and Δ COVE was uncorrelated (r = -0.218, P = 0.059). The areas under the ROC curve of ΔCOPLR, SVV predicting fluid responsiveness were 0.859 and 0.459 respectively. The ΔCOPLR ≥ 10% was found to predict fluid responsiveness with a sensitivity and specificity of 85% and 83% respectively.
Compared with SVV, PLR test is a simple, effective method for accurately predicting fluid responsiveness of elderly patients with sepsis.
探讨基于生物反应技术的被动抬腿（PLR）试验对老年脓毒症患者液体反应性的预测价值。
这项前瞻性自我对照临床研究纳入了浙江医院重症医学科的31例老年脓毒症患者。在PLR和容量扩充（VE）试验前后，使用基于生物反应技术的设备（无创心输出量监测仪，NICOM）连续记录包括心输出量（CO）、每搏量变异度（SVV）在内的血流动力学参数。若VE后CO增加≥10%，则患者被定义为有反应者。
对这31例患者共进行了100次PLR和VE试验评估。在28例有反应者中，PLR和VE后CO[（5.11±2.10）L/min对（5.91±2.45）L/min，P<0.05；（5.06±2.06）L/min对（5.77±2.47）L/min，P<0.05]和SV[（59.61±18.22）ml对（69.29±21.32）ml，P<0.05；（60.10±15.95）ml对（70.06±17.96）ml，P<0.05]均明显增加。PLR后的ΔCO（ΔCOPLR）与ΔCOVE高度相关（r=0.819，P=0.001），而VE前的SVV与ΔCOVE不相关（r=-0.218，P=0.059）。ΔCOPLR、SVV预测液体反应性的ROC曲线下面积分别为0.859和0.459。发现ΔCOPLR≥10%预测液体反应性的敏感度和特异度分别为85%和83%。
与SVV相比，PLR试验是准确预测老年脓毒症患者液体反应性的一种简单、有效的方法。
