| 乔志飞,张丽骞,王 磊,翟丽萍,李福龙,马 靖.床旁超声联合血乳酸对感染性休克患者容量反应性的预测价值分析[J].,2022,(2):333-336 |
| 床旁超声联合血乳酸对感染性休克患者容量反应性的预测价值分析 |
| Predictive Value of Bedside Ultrasound Combined with Serum Lactic Acid on Volume Responsiveness of Patients with Septic Shock |
| 投稿时间：2021-06-13 修订日期：2021-07-10 |
| DOI：10.13241/j.cnki.pmb.2022.02.026 |
| 中文关键词: 感染性休克 容量反应性 床旁超声 血乳酸 预测价值 |
| 英文关键词: Septic shock Volume responsiveness Bedside ultrasound Blood lactic acid Predictive value |
| 基金项目:国家自然科学基金项目（81073171）；张家口市科技计划项目（1521081D） |
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| 中文摘要: |
| 摘要 目的：研究床旁超声与血乳酸（LAC）联合应用于感染性休克患者容量反应性预测中的效能。方法：选取2015年10月～2017年10月于我院接受治疗的120例感染性休克患者进行研究。对所有患者均开展补液试验，并按照试验结果的差异将其分作反应组63例和无反应组57例。对两组人员均实施床旁超声检查以及LAC水平检测，并对比相关指标水平。通过Pearson相关性分析明确感染性休克患者床旁超声指标与LAC水平的关系。采用受试者工作特征（ROC）曲线分析床旁超声与LAC联合预测上述患者容量反应性的效能。结果：两组补液后平均动脉压（MAP）、中心静脉压（CVP）均高于补液前（P＜0.05），反应组补液前下腔静脉呼吸变异率（△IVC）、主动脉峰值流速呼吸变异率（△VpeakAO）、肱动脉最大速度变异率（△VpeakBA）高于补液后及无反应组（P＜0.05）。两组补液后LAC水平均低于补液前，且反应组低于无反应组（P＜0.05）。经Pearson相关性分析可得：感染性休克患者LAC水平与△IVC、△VpeakAO、△VpeakBA均呈正相关（P＜0.05）。经ROC曲线分析可知：床旁超声联合LAC预测感染性休克患者容量反应性的曲线下面积、灵敏度、特异度以及约登指数均高于床旁超声和LAC单独预测。结论：感染性休克患者补液后LAC水平降低，床旁超声联合LAC预测感染性休克患者容量反应性的效能较高，具有一定的临床应用价值。 |
| 英文摘要: |
| ABSTRACT Objective: To study the efficacy of bedside ultrasound combined with serum lactic acid (LAC) in volume responsiveness of patients with septic shock. Methods: A total of 120 patients with septic shock who received diagnosis and treatment in our hospital from October 2015 to October 2017 were selected for the study. Rehydration test was carried out for all patients, and they were divided into response group with 63 cases and non-response group with 57 cases according to the difference of test results. Bedside ultrasound examination and LAC level detection were performed for two groups, and the levels of relevant indicators were compared. Pearson correlation analysis was used to determine the relationship between bedside ultrasound index and LAC level in patients with septic shock. Receiver operating characteristic (ROC) curve analysis was used to determine the efficacy of bedside ultrasound combined with LAC in predicting volume responsiveness of the above patients. Results: The mean arterial pressure (MAP) and central venous pressure (CVP) of the two groups after rehydration were higher than those before rehydration(P＜0.05). The variation rate of respiration of inferior vena cava (△IVC), peak velocity of aorta (△VpeakAO) and maximum velocity of brachial artery (△VpeakBA) in the response group before rehydration were higher than those after rehydration and the non-response group(P＜0.05). The LAC level after rehydration was lower than that before rehydration in two groups, and that in response group was lower than that in non-response group(P＜0.05). Pearson correlation analysis showed that LAC level was positively correlated with △IVC, △VpeakAO and △VpeakBA(P＜0.05). The ROC curve analysis showed that the area under the curve, sensitivity, specificity and Youden index of the volume responsiveness of patients with septic shock predicted by bedside ultrasound combined with LAC were higher than those predicted by bedside ultrasound and LAC alone. Conclusion: The LAC level of patients with septic shock decreased after rehydration. The potency of bedside ultrasound combined with LAC in predicting volume responsiveness of patients with septic shock is high, which has certain clinical application value. |
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