被动抬腿引起的 ScvO 变化能否预测液体反应性？一项前瞻性研究。

Do ScvO variations induced by passive leg raising predict fluid responsiveness? A prospective study.

机构信息

Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland.

Faculty of Medicine, University of Geneva, Geneva, Switzerland.

出版信息

Physiol Rep. 2021 Sep;9(17):e15012. doi: 10.14814/phy2.15012.

DOI:10.14814/phy2.15012

PMID:34491003

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8422598/

Abstract

OBJECTIVE

The present study investigates whether ScvO variations induced by passive leg raising (PLR) are able to predict fluid responsiveness (FR) in mechanically ventilated patients.

DESIGN

A monocentric prospective clinical study.

SETTING

An intensive care division in a tertiary hospital.

PATIENTS

The inclusion criteria were elective postoperative cardiac surgery patients who were over 18 years old, deeply sedated, mechanically ventilated and needed volume expansion (VE). Fluid responders (R) were defined as patients who increased their left ventricular outflow tract velocity time integral (VTI) ≥15% after VE.

INTERVENTION

In patients included in this study, continuous ScvO monitoring (CeVOX device, Pulsion Medical Systems) and VTI (transthoracic echocardiography) were measured simultaneously before and during a PLR test and before and after VE (with 500 ml of saline).

MEASUREMENTS AND MAIN RESULTS

Thirty-three consecutive patients were included in this study. In 15 patients with a positive PLR test (increase in VTI ≥15%), ScvO increased during PLR by 9 ± 4%. In the 18 patients with a negative PLR test, ScvO did not significantly change during PLR. VE increased ScvO by 9 ± 6% and 2 ± 4% in responders and nonresponders, respectively. If ScvO increased by >4% during the PLR test, then a positive VTI response (≥15%) was diagnosed with a sensitivity of 93% (68-99%) and a specificity of 94% (63-99%) (Area under the receiver operating characteristic curve 0.92 ± 0.58, p < 0.05). Moreover, ScvO variations were able to distinguish responders to VE from nonresponders to VE with a sensitivity of 87% (68-99%) and a specificity of 89% (63-99%) (Area under the receiver operating characteristic curve 0.89 ± 0.07, p < 0.05).

CONCLUSIONS

ScvO variation induced by PLR is a reliable, minimally invasive parameter for predicting FR at the postoperative cardiac surgery bedside of mechanically ventilated, critically ill patients.

摘要

目的

本研究旨在探讨被动抬腿（PLR）引起的中心静脉血氧饱和度（ScvO ）变化是否能够预测机械通气患者的液体反应性（FR）。

设计

单中心前瞻性临床研究。

地点

一家三级医院的重症监护病房。

患者

入选标准为择期心脏手术后 18 岁以上、深度镇静、机械通气并需要容量扩充（VE）的成年患者。液体反应者（R）定义为 VE 后左心室流出道速度时间积分（VTI）增加≥15%的患者。

干预

在本研究中，连续监测 ScvO （Pulsion Medical Systems 公司的 CeVOX 设备）和 VTI（经胸超声心动图），在 PLR 试验前后以及 VE（500ml 生理盐水）前后同时进行测量。

测量和主要结果

本研究共纳入 33 例连续患者。在 15 例 PLR 试验阳性（VTI 增加≥15%）的患者中，ScvO 在 PLR 期间增加了 9±4%。在 18 例 PLR 试验阴性的患者中，ScvO 在 PLR 期间无显著变化。VE 使 ScvO 分别增加了 9±6%和 2±4%，在反应者和非反应者中。如果 PLR 试验期间 ScvO 增加>4%，则阳性 VTI 反应（≥15%）的诊断灵敏度为 93%（68-99%），特异性为 94%（63-99%）（受试者工作特征曲线下面积 0.92±0.58，p<0.05）。此外，ScvO 变化能够以 87%（68-99%）的灵敏度和 89%（63-99%）的特异性区分 VE 反应者和非反应者（受试者工作特征曲线下面积 0.89±0.07，p<0.05）。