Xiang Si, Muyun Huang, Juan Chen, Bin Ouyang, Minying Chen, Changjie Cai, Jianfeng Wu, Zimeng Liu, Yongjun Liu, Shunwei Huang, Lifen Li, Xiangdong Guan
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015 Sep;27(9):729-34.
To assess the value of passive leg raising (PLR) test in predicting fluid responsiveness in patients with sepsis-induced cardiac dysfunction.
A prospective observational cohort study was conducted. Thirty-eight patients under mechanical ventilation suffering from sepsis-induced cardiac dysfunction admitted to Department of Surgical Intensive Care Unit of First Affiliated Hospital of Sun Yat-Sen University from September 2013 to July 2014 were enrolled. The patients were studied in four phases: before PLR (semi-recumbent position with the trunk in 45°), PLR (the lower limbs were raised to a 45° angle while the trunk was in a supine position), before volume expansion (VE, return to the semi-recumbent position), and VE with infusing of 250 mL 5% albumin within 30 minutes. Hemodynamic parameters were recorded in every phase. The patients were classified into two groups according to their response to VE: responders (at least a 15% increase in stroke volume, A SV(VE) ≥ 15%), and non-responders. The correlations among all changes in hemodynamic parameters were analyzed by linear correlation analysis, and the receiver operating characteristic curve (ROC) was plotted to assess the value of hemodynamic parameters before and after PLR in predicting fluid responsiveness.
Of 38 patients, 25 patients were responders, and 13 non-responders. There was no significant difference in the baseline and hemodynamic parameters at semi-recumbent position between the two groups. The changes in SV and cardiac output (CO) after PLR (Δ SV(PLR) and Δ CO(PLR)) were significantly higher in responders than those of non-responders [ Δ SV(PLR): (14.7 ± 5.7)% vs. (6.4 ± 5.3)%, t = 4.304, P = 0.000; ΔCO(PLR): (11.2 ± 7.5)% vs. (3.4 ± 2.3)%, t = 3.454, P = 0.001], but there was no significant difference in the changes in systolic blood pressure, mean arterial pressure, pulse pressure, and heart rate after PLR (Δ SBP(PLR), Δ MAP(PLR), Δ PP(PLR) and Δ HR(PLR)) between two groups. Δ SV(VE) in responders was significantly higher than that of the non-responders [(20.8 ± 5.5) % vs. (5.0 ± 3.7) %, t = 8.347, P = 0.000]. It was shown by correlation analysis that ΔSV(PLR) was positively correlated with Δ SV(VE) (r = 0.593, P = 0.000), Δ CO(PLR) was positively correlated with ΔSV(VE) (r = 0.494, P = 0.002). The area under ROC curve (AUC) of Δ SV(PLR) ≥ 8.1% for predicting fluid responsiveness was 0.860 ± 0.062 (P = 0.000), with sensitivity of 92.0% and specificity of 70.0%; the AUC of Δ CO(PLR) ≥ 5.6% for predicting fluid responsiveness was 0.840 ± 0.070 (P = 0.000), with sensitivity of 84.0% and specificity of 76.9%; the AUC of Δ MAP(PLR) ≥ 6.9% for predicting fluid responsiveness was 0.662 ± 0.089, with sensitivity of 68.0% and specificity of 76.9%; the AUC of Δ SBP(PLR) ≥ 6.4% for predicting fluid responsiveness was 0.628 ± 0.098, with sensitivity of 76.0% and specificity of 61.5%; the AUC of Δ PP(PLR) ≥ 6.2% for predicting fluid responsiveness was 0.502 ± 0.094, with sensitivity of 56.0% and specificity of 53.8%; the AUC of Δ HR(PLR) ≥ -1.7% for predicting fluid responsiveness was 0.457 ± 0.100, with sensitivity of 56.0% and specificity of 46.2%.
In patients with sepsis-induced cardiac dysfunction, changes in SV and CO induced by PLR are accurate indices for predicting fluid responsiveness, but the changes in HR, MAP, SBP and PP cannot predict the fluid responsiveness.
评估被动抬腿（PLR）试验对脓毒症诱发心功能不全患者液体反应性的预测价值。
进行一项前瞻性观察性队列研究。纳入2013年9月至2014年7月在中山大学附属第一医院外科重症监护室住院的38例机械通气的脓毒症诱发心功能不全患者。对患者进行四个阶段的研究：PLR前（半卧位，躯干呈45°）、PLR（下肢抬高至45°角，躯干仰卧位）、扩容前（VE，恢复半卧位）以及在30分钟内输注250 mL 5%白蛋白的VE阶段。记录每个阶段的血流动力学参数。根据患者对VE的反应将其分为两组：反应者（每搏量至少增加15%，ΔSV(VE)≥15%）和无反应者。通过线性相关分析分析血流动力学参数所有变化之间的相关性，并绘制受试者工作特征曲线（ROC）以评估PLR前后血流动力学参数对液体反应性的预测价值。
38例患者中，25例为反应者，13例为无反应者。两组半卧位时的基线和血流动力学参数无显著差异。反应者PLR后每搏量（SV）和心输出量（CO）的变化（ΔSV(PLR)和ΔCO(PLR)）显著高于无反应者[ΔSV(PLR)：(14.7±5.7)%对(6.4±5.3)%，t = 4.304，P = 0.000；ΔCO(PLR)：(11.2±7.5)%对(3.4±2.3)%，t = 3.454，P = 0.001]，但两组PLR后收缩压、平均动脉压、脉压和心率的变化（ΔSBP(PLR)、ΔMAP(PLR)、ΔPP(PLR)和ΔHR(PLR)）无显著差异。反应者的ΔSV(VE)显著高于无反应者[(20.8±5.5)%对(5.0±3.7)%，t = 8.347，P = 0.000]。相关性分析显示，ΔSV(PLR)与ΔSV(VE)呈正相关（r = 0.593，P = 0.000），ΔCO(PLR)与ΔSV(VE)呈正相关（r = 0.494，P = 0.002）。预测液体反应性时，ΔSV(PLR)≥8.1%的ROC曲线下面积（AUC）为0.860±0.062（P = 0.000），敏感性为92.0%，特异性为70.0%；ΔCO(PLR)≥5.6%预测液体反应性的AUC为0.840±0.070（P = 0.000），敏感性为84.0%，特异性为76.9%；ΔMAP(PLR)≥6.9%预测液体反应性的AUC为0.662±0.089，敏感性为68.0%，特异性为76.9%；ΔSBP(PLR)≥6.4%预测液体反应性的AUC为0.628±0.098，敏感性为76.0%，特异性为61.5%；ΔPP(PLR)≥6.2%预测液体反应性时的AUC为0.502±0.094，敏感性为56.0%，特异性为53.8%；ΔHR(PLR)≥ -1.
