摘要目的 探讨每搏变异度(stroke volume variation,SVV)在感染性休克患者容量评估中的应用.方法 前瞻性观察研究,对2009年12月至2012年3月,合肥市第一人民医院ICU收治的32例机械通气感染性休克患者给予补液试验(生理盐水250mL于10 min内静脉输注),采用FloTrac/Vigileo监护系统监测心脏指数(cardiac index,CI)、每搏输出量(stroke volume,SV)、外周血管阻力指数(systemic vascular resistance index,SVRI)、SVV等血流动力学指标.以SV增加值(△SV) ＞10％为容量反应阳性,分为反应组和无反应组,组间比较应用两独立样本t检验;容量负荷试验前后比较应用配对t检验;变量相关性采用Pearson相关分析;受试者工作特征曲线评价SVV、中心静脉压(central venous pressure,GVP)、平均动脉压(mean artery pressure,MAP)以及容量负荷试验前后CVP变化值(△CVP)、MAP变化值(△MAP)预测容量反应性的价值.结果 32例患者共行54次补液实验,其中反应组35例次,无反应组19例次.反应组补液实验后SV较之前明显增加[(83.6±15.6) mLvs.(68.5±14.2) mL,P＜0.01],无反应组补液实验前后SV无明显变化(P＞0.05).每搏变异度(SVV)与△SV 呈正相关(r =0.522,P＜0.01),SVV预测容量反应性的ROC曲线分析结果示,AUC为0.898 (95％ CI:0.796 ～ 1.000),以SVV≥11.5％预测容量反应性,灵敏度为0.94,特异度为0.84.结论 SVV可用于评估感染性休克患者的容量反应,可作为指导容量治疗的指标.

abstractsObjective To determine whether stroke volume variation (SVV) in relation to volume loading in mechanically ventilated patients with septic shock.Methods Data of thirty-two mechanically ventilated patients with septic shock admitted from Dec 2009 to May 2012 were prospectively analyzed.Cardiac index (CI),stroke volume (SV),systemic vascular resistance index (SVRI) and stroke volume variation (SVV) were measured by FloTrac/Vigileo before and after fluid resuscitation (250 mL saline in 10 min).Patients with an increase in SV (△SV) ≥ 10％ and ＜ 10％ after fluid volume loading were classified as responders and non-responders,respectively.The comparisons between these two sorts of patients were assessed by using two sample Student' s t-test,and comparisons between changes before and after fluid challenge were assessed by using a paired Student' s t-test.A Pearson' s correlation analysis was employed for evaluate the correlation between △SV and other haemodynamic variables.The roles of SVV,central venous pressure (CVP),mean artery pressure (MAP) and the changes of CVP (△CVP),MAP (△MAP) after fluid administration in predicting volume responsiveness were evaluated by receiver operating characteristic (ROC) curve.Results Thirty-two patients with septic shock were included in this study.There were 54 instances of fluid challenge performed,among which 35 instances were defined as response group.Significantly increased SV induced by fluid challenge was assigned into response group (83.6 ± 15.6) mL vs.(68.5 ± 14.2) mL,P ＜0.01,while in non-response group,there were no significant change in SV (P ＞0.05).SVV was significantly correlated with SV before fluid loading (r =0.522,P ＜ 0.01).The area under the ROC curve (AUC) for stroke volume variation (SVV) was 0.898 (95％ CI:0.796-1.000).Using SVV ≥ 11.5％ as the threshold to predict fluid responsiveness,the sensitivity was 94％ and specificity was 84％.Conclusions SVV can be used to predict fluid responsiveness in patients with septic shock.