| 摘要: |
| 目的探讨无创心输出量监护（NICOM）对心脏瓣膜手术后患者容量反应性的预测价值。方法选取择期行体外循环下心脏瓣膜置换术患者52例，术后均在外科重症监护室机械通气期间行NICOM监护，同时行被动抬腿试验（PLR）并随后进行补液试验。以补液试验后每搏输出量（SV）增加≥10%为患者有容量反应性（反应组，19例），SV增加＜10%为无容量反应性（无反应组，33例），分析在NICOM监护下PLR前后ΔSV与患者容量反应性的相关性。结果两组患者PLR后及补液试验后平均动脉压、心指数、SV均分别较PLR前及补液试验前明显升高（均P＜0.05），每搏变异度均明显降低（均P＜0.05），而心率变化均无统计学差异（均P＞0.05）。反应组患者PLR前后ΔSV与补液试验前后ΔSV呈正相关（r=0.407，P＜0.05）。反应组患者PLR前后以ΔSV≥9.0%为界值点预测容量反应性的灵敏度为89.5%，特异度为45.5%，ROC曲线下面积为0.741（95%CI：0.607～0.874）。结论NICOM作为一种无创的连续血流动力学监护方法，结合PLR用于心脏瓣膜手术后患者的容量管理有一定价值。 |
| 关键词: 被动抬腿试验 心脏瓣膜手术 每搏输出量 容量反应性 |
| DOI： |
| 分类号: |
| 基金项目:浙江省重点科技创新团队项目重症医学科技创新团队 |
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| Passive leg raising test with non-invasive cardiac output monitoring in prediction of volume responsiveness for patients undergoing heart valve surgery |
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Lu Xing, XIA Yanfei, ZHENG Xiaozhu
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Zhejiang Hospital
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| Abstract: |
| Objective To investigate passive leg raising (PLR) test with non-invasive cardiac output monitoring (NICOM)
in prediction of volume responsiveness for patients undergoing cardiac valve surgery. Methods Fifty two adult patients underwent valve replacement surgery, PLR test and NICOM were performed and volume expansion was given immediately after surgery. Stroke volume(SV) and cardiac index(CI) were measured with NICOM during volume expansion. Patients were classified as responders or non-responder if stroke volume (SV) increased ≥10% or ＜10% after volume expansion. PLR test for predicting volume responsiveness was evaluated by receiver operating characteristic (ROC) curve. Results Among 52 patients, 19 were responders and 33 were non-responders. MBP, CI, SV induced by PLR and volume expansion were increased significantly in both groups (P＜0.05) .ΔSV induced by PLR was correlated to SV after volume expansion (r=0.407, P＜0.05) in responders. The area under the ROC curve (AUC) for PLR in predicting volume responsiveness was 0.741 (95% CI:0.607~0.874) . With ΔSV induced by PLR ≥9.0% as cut-off value, the sensitivity and specificity were 89.5% and 45.5%, respectively for predicting volume responsiveness. Conclusion PLR combined with NICOM can be used for prediction of volume responsiveness in fluid therapy for patients after heart valve surgery. |
| Key words: Passive leg raising Cardiac valvular surgery Stroke volume Volume responsiveness |
