Trifi A, Abdellatif S, Daly F, Nasri R, Touil Y, Ben Lakhal S
Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia; Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.
Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia; Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.
Med Intensiva (Engl Ed). 2019 Jan-Feb;43(1):10-17. doi: 10.1016/j.medin.2017.11.002. Epub 2017 Dec 16.
To assess the performance of the ultrasound measurement of stroke volume (SV) coupled to passive leg raising (PLR) in predicting fluid responsiveness (FR).
A prospective cohort study was carried out in patients requiring volume expansion (VE). A transthoracic Doppler echocardiography (TTE) device was used for the measurement of SV. Four measurements were obtained: before and 90s after PLR, and before and after VE. The patients were subsequently classified according to their hemodynamic response to VE. Responders were defined by an increase in SV of at least 15% in response to VE.
Thirty maneuvers were studied. An increase in SV>15% in response to PLR was recorded in 21 cases. Hemodynamic indices taken in the first stage showed significant differences in the distensibility index of the inferior vena cava (dIVC), in the velocity-time integral of aortic blood flow (VTIAo) and in SV, with respective p-values of 0.009, 0.012 and 0.025. The SV changes induced by VE were significantly correlated to the SV changes induced by PLR, with a Spearman coefficient of 0.77 and a linear equation y=0.82 x+1.68. Fluid responsiveness can be efficiently predicted by assessing the effects of PLR on SV monitored by Doppler TTE, with a sensitivity of 94.7% and a negative predictive value of 88%.
Our data support the interest of Doppler TTE as an effective tool in predicting FR through the assessment of SV in response to PLR, in hemodynamically unstable patients.
评估与被动抬腿（PLR）相结合的每搏输出量（SV）超声测量法在预测液体反应性（FR）方面的性能。
对需要进行容量扩充（VE）的患者开展了一项前瞻性队列研究。使用经胸多普勒超声心动图（TTE）设备测量SV。共进行了四次测量：PLR前、PLR后90秒、VE前及VE后。随后根据患者对VE的血流动力学反应进行分类。反应者定义为对VE反应时SV至少增加15%。
研究了30次操作。21例患者记录到PLR后SV增加>15%。第一阶段采集的血流动力学指标在下腔静脉扩张指数（dIVC）、主动脉血流速度时间积分（VTIAo）和SV方面存在显著差异，p值分别为0.009、0.012和0.025。VE引起的SV变化与PLR引起的SV变化显著相关，Spearman系数为0.77，线性方程为y = 0.82x + 1.68。通过评估PLR对多普勒TTE监测的SV的影响，可以有效预测液体反应性，敏感性为94.7%，阴性预测值为88%。
我们的数据支持在血流动力学不稳定的患者中，多普勒TTE作为一种通过评估PLR反应时的SV来预测FR的有效工具的价值。
