去甲肾上腺素影响脓毒性休克被动抬腿试验判断液体反应性的临床研究_《中国呼吸与危重监护杂志》

作者：

南京大学医学院附属鼓楼医院重症医学科(江苏南京 210008);

关键词：

脓毒性休克去甲肾上腺素液体反应性心脏前负荷心排出量被动抬腿试验

DOI：

10.7507/1671-6205.2014038

视频：

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目的探讨去甲肾上腺素对脓毒性休克患者被动抬腿试验(PLR)预测液体反应性的影响。方法采用前瞻性观察研究的方法,收集2012年9月至2012年11月南京大学医学院附属鼓楼医院重症医学科收治的46例脓毒性休克患者的临床资料,其中36例PLR阳性患者纳入研究,以PLR实施1 min后每博输出量指数(SVI)增加(ΔSVI=SVI变化值/基础SVI)≥10%,定义为PLR阳性,提示有液体反应性。纳入研究后患者均先行第1次PLR(PLR1),然后体位改为平卧并稳定}后,给予去甲肾上腺素静脉泵入或增加去甲肾上腺素治疗剂量维持MAP≥65 mm Hg,稳定20 min后,行第2次PLR(PLR2)。采用脉搏轮廓连续心排出量监测(PiCCO)法监测患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排指数(CI)、每搏输出量指数(SVI)、外周血管阻力指数(SVRI)、全心舒张末期容积指数(GEDVI)、心功能指数(CFI)等血流动力学指标。观察患者去甲肾上腺素治疗后PLR及其他血流动力学监测指标的变化。结果实施PLR1时SVI增加,ΔSVI为(20.54±9.63)%,CI增加(20.57±9.89)%,MAP升高(7.64±5.77)%,CVP亦升高(25.83±23.39)%。给予去甲肾上腺素静脉泵入或增加去甲肾上腺素治疗剂量后SVI增加,ΔSVI(16.97±9.06)%,CI增加(16.78±8.39)%,GEDVI增加(9.08±4.47)%MAP升高(28.07±12.48)%,CVP增加(7.86±8.52)%。实施PLR2时SVI增加,ΔSVI(13.74±8.79)%,CI增加(13.79±9.08)%,MAP升高(2.93±5.06)%,CVP升高(13.36±4.74)%,与PLR1比较,去甲肾上腺素治疗后及PLR2时ΔSVI均显著降低(P均＜0.05)。实施PLR2时6例患者SVI增加＜10%,即无液体反应性。结论去甲肾上腺素增加PLR阳性脓毒性休克患者的心脏前负荷,增加心排出量,影响液体反应性。

引用本文： 刘洋, 顾勤, 刘宁, 徐颖, 陈鸣. 去甲肾上腺素影响脓毒性休克被动抬腿试验判断液体反应性的临床研究. 中国呼吸与危重监护杂志, 2013, 12(2): 154-157. doi: 10.7507/1671-6205.2014038 复制

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10.	Marik PE,Cavallazzi R,Vasu T,et al.Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients:a systematic review of the literature.Crit Care Med,2009,37:2642-2647.
11.	Monnet X,Jabot J,Maizel J,et al.Norepinephrine increases cardiac preload and reduces preload dependency assessed by passive leg raising in septic shock patients.Crit Care Med,2011,39:689-694.
12.	Datta P,Magder S.Hemodynamic response to norepinephrine with and without inhibition of nitric oxide synthase in porcine endotoxemia.Am J Respir Crit Care Med,1999,160:1987-1993.
13.	Holmes CL.Vasoactive drugs in the intensive care unit.Curr Opin Crit Care,2005,11:413-417.
14.	Persichini R,Silva S,Teboul JL,et al.Effects of Norepinephrine on Mean Systemic Pressure and Venous Return in Human Septic Shock.Crit Care Med,2012,40:3146-3153.

1. Michard F,Teboul JL.Predicting fluid responsiveness in ICU patients:a critical analysis of the evidence.Chest,2002,121:2000-2008.
2. Hamzaoui O,Georger JF,Monnet X,et al.Early administration of norepinephrine increases cardiac preload and cardiac output in septic patients with life-threatening hypotension.Critical Care,2010,14:R142.
3. Levy MM,Fink MP,Marshall JC,et al.2001 SCCM／ESICM／ACCP／ATS／SIS international sepsis definitionsconference.Crit Care Med,2003,31:1250-1256.
4. Preau S,Saulnier F,Dewavrin F,et al.Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis.Crit Care Med,2010,38:819-825.
5. 张少雷,孙荣青.血管升压药物在感染性休克中的应用.中国呼吸与危重监护杂志,2011,10:209-210.
6. Cavallaro F,Sandroni C,Antonelli M.Functional hemodynamic monitoring and dynamic indices of fluid responsiveness.Minerva Anestesiol,2008,74:123-135.
7. Chew MS,Åneman A.Haemodynamic monitoring using arterial waveform analysis.Curr Opin Crit Care,2013,19:234-241.
8. Cavallaro F,Sandroni C,Marano C,et al.Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies.Intensive Care Med,2010,36:1475-1483.
9. Préau S,Saulnier F,Dewavrin F,et al.Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis.Crit Care Med,2010,38:819-825.
10. Marik PE,Cavallazzi R,Vasu T,et al.Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients:a systematic review of the literature.Crit Care Med,2009,37:2642-2647.
11. Monnet X,Jabot J,Maizel J,et al.Norepinephrine increases cardiac preload and reduces preload dependency assessed by passive leg raising in septic shock patients.Crit Care Med,2011,39:689-694.
12. Datta P,Magder S.Hemodynamic response to norepinephrine with and without inhibition of nitric oxide synthase in porcine endotoxemia.Am J Respir Crit Care Med,1999,160:1987-1993.
13. Holmes CL.Vasoactive drugs in the intensive care unit.Curr Opin Crit Care,2005,11:413-417.
14. Persichini R,Silva S,Teboul JL,et al.Effects of Norepinephrine on Mean Systemic Pressure and Venous Return in Human Septic Shock.Crit Care Med,2012,40:3146-3153.

《中国呼吸与危重监护杂志》

去甲肾上腺素影响脓毒性休克被动抬腿试验判断液体反应性的临床研究

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《中国呼吸与危重监护杂志》

去甲肾上腺素影响脓毒性休克被动抬腿试验判断液体反应性的临床研究

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