每搏量变异度预测重度颅脑损伤患者容量反应性价值.docVIP

每搏量变异度预测重度颅脑损伤患者容量反应性价值 　　[摘要] 目的 探?重度颅脑损伤患者进行液体治疗时每搏变异度（SVV）对容量反应性的预测价值。 方法 选取本院重症医学科于2014年6月～2016年5月间收治的重度颅脑损伤患者47例作为研究对象。所有患者在平均动脉压（MAP）持续低于80 mmHg时，以250 mL生理盐水于10 min内输注完毕，并分别于液体治疗前后测量各项血流动力学参数。依据液体治疗前后心排指数（CI）增加（ΔCI≥15%）的患者作为有反应组，共26例，将ΔCI0.05）。液体治疗前有反应组的SVV高于无反应组，其差异有高度统计学意义（P0.05）；液体治疗前SVV与ΔCI呈直线相关（r=0.767，P=0.000）；CVP、MAP、HR、SV、SVI与ΔCI无明显相关（r=-0.146，P=0.326；r=0.140，P=0.346；r=-0.028，P=0.851；r=-0.138，P=0.354；r=-0.191，P=0.199）；SVV曲线下面积为0.885（95%CI 0.792～0.976，P=0.000），以SVV12.5%为切点预测重度颅脑损伤患者容量反应性的敏感度为76.9%，特异度为76.2%。 结论 SVV可用于评估重度颅脑损伤患者的容量反应，作为指导容量治疗的指标。 　　[关键词] 重度颅脑损伤；每搏变异度；容量反应；液体治疗 　　[中图分类号] R459.7 [文献标识码] A [文章编号] 1673-9701（2017）27-0004-04 　　Value of stroke volume variation in predicting the volume responsiveness of patients with severe craniocerebral injury 　　LI Tong2 YIN Qiqi2 WANG Bin2 ZHENG Yong2 PAN Leijie2 　　1.Department of Emergency， the First Hospital Affiliated to Zhejiang University， Hangzhou 310000， China； 2.Department of ICU， Anji County Third People’s Hospital in Zhejiang Province， Anji 313300， China 　　[Abstract] Objective To investigate the predictive value of stroke volume variation （SVV） on volume responsiveness in the patients with severe craniocerebral injury during fluid therapy. Methods A total of 47 patients with severe craniocerebral injury who were admitted to the Department of ICU in our hospital from June 2014 to May 2016 were selected as the study subjects. All patients were given infusion of 250 mL normal saline within 10 min when the mean arterial pressure （MAP） was lower than 80 mmHg continuously. The hemodynamic parameters were measured before and after fluid therapy. A total of 26 patients whose CI was increased（ΔCI≥15%） before and after fluid therapy were selected as the response group. A total of 21 patients with ΔCI0.05）. SVV in the response group was higher than that in the non-response group before fluid therapy， and there was statistically significant difference（P0.05）； there was a linear correlation between SVV a