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目的探讨每搏量变异(SVV)对感染性休克患者容量反应预测的准确性,为临床诊治感染性休克提供参考依据。方法选择2013年8月至2015年9月期间收治的40例外科感染性休克患者为研究对象,以羟乙基淀粉静脉输注做容量负荷试验,以每搏量指数(SVI)作为容量反应性指标,SVI增值≥10%为有反应组,SVI增值<10%为无反应组。应用PICCO监测仪测量扩容前后患者的中心静脉压(CVP)、心率(HR)、平均动脉压(MAP)、心输出量(CO)、SVI、SVV等,并详细记录。探讨SVV对容量反应的预测价值,并通过绘制ROC曲线,分析SVV监测容量反应性的敏感度和特异度。结果 40例患者中,30例容量反应阳性,10例容量反应为阴性;两组HR、MAP、CO、CVP、SVI等血流动力学指标在容量负荷试验前(基础值)与试验后比较差异均无统计学意义(P均>0.05),但在容量负荷后两组SVV值比较差异有统计学意义(P<0.01)。ROC曲线分析表明:SVV监测容量反应性的阈值为12.5%时,其特异性为100%,灵敏度为80%,曲线下面积为0.747(95%CI:0.544~0.953)。结论 SVV可作为临床预测感染性休克患者补液治疗容量反应性的常规指标。
Objective To investigate the accuracy of stroke volume variation (SVV) in predicting volume response in patients with septic shock and provide a reference for the clinical diagnosis and treatment of septic shock. Methods Forty patients with surgical septic shock admitted from August 2013 to September 2015 were enrolled in this study. The volume load test was performed by intravenous infusion of hydroxyethyl starch and the stroke volume index (SVI) was used as the volume responsiveness Indicators, SVI value ≥ 10% for the response group, SVI value <10% for the non-response group. The patients’ central venous pressure (CVP), heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), SVI and SVV were measured with PICCO before and after the expansion. To investigate the predictive value of SVV for volume response and to plot the sensitivity and specificity of SVR for monitoring volume responsiveness by plotting ROC curves. Results Among the 40 patients, the volume response was positive in 30 patients and the volume response was negative in 10 patients. The hemodynamic indexes such as HR, MAP, CO, CVP and SVI in the two groups were significantly different from those before the volume load test (baseline) (P> 0.05). However, there was significant difference in SVV between two groups after volume load (P <0.01). ROC curve analysis showed that the specificity of the SVV monitoring volume reactivity threshold was 12.5% with a specificity of 100%, a sensitivity of 80% and an area under the curve of 0.747 (95% CI: 0.544 to 0.953). Conclusions SVV can be used as a routine index to predict the volume response of rehydration therapy in patients with septic shock.