去甲腎上腺素影響膿毒性休克被動抬腿試驗判斷液體反應性的臨床研究_《中國呼吸與危重監護雜志》

作者：

南京大學醫學院附屬鼓樓醫院重癥醫學科(江蘇南京 210008);

關鍵詞：

膿毒性休克去甲腎上腺素液體反應性心臟前負荷心排出量被動抬腿試驗

DOI：

10.7507/1671-6205.2014038

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目的探討去甲腎上腺素對膿毒性休克患者被動抬腿試驗(PLR)預測液體反應性的影響。方法采用前瞻性觀察研究的方法,收集2012年9月至2012年11月南京大學醫學院附屬鼓樓醫院重癥醫學科收治的46例膿毒性休克患者的臨床資料,其中36例PLR陽性患者納入研究,以PLR實施1 min后每博輸出量指數(SVI)增加(ΔSVI=SVI變化值/基礎SVI)≥10%,定義為PLR陽性,提示有液體反應性。納入研究后患者均先行第1次PLR(PLR1),然后體位改為平臥并穩定}后,給予去甲腎上腺素靜脈泵入或增加去甲腎上腺素治療劑量維持MAP≥65 mm Hg,穩定20 min后,行第2次PLR(PLR2)。采用脈搏輪廓連續心排出量監測(PiCCO)法監測患者心率(HR)、平均動脈壓(MAP)、中心靜脈壓(CVP)、心排指數(CI)、每搏輸出量指數(SVI)、外周血管阻力指數(SVRI)、全心舒張末期容積指數(GEDVI)、心功能指數(CFI)等血流動力學指標。觀察患者去甲腎上腺素治療后PLR及其他血流動力學監測指標的變化。結果實施PLR1時SVI增加,ΔSVI為(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)%。給予去甲腎上腺素靜脈泵入或增加去甲腎上腺素治療劑量后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)%。實施PLR2時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)%,與PLR1比較,去甲腎上腺素治療后及PLR2時ΔSVI均顯著降低(P均＜0.05)。實施PLR2時6例患者SVI增加＜10%,即無液體反應性。結論去甲腎上腺素增加PLR陽性膿毒性休克患者的心臟前負荷,增加心排出量,影響液體反應性。

引用本文： 劉洋, 顧勤, 劉寧, 徐穎, 陳鳴. 去甲腎上腺素影響膿毒性休克被動抬腿試驗判斷液體反應性的臨床研究. 中國呼吸與危重監護雜志, 2013, 12(2): 154-157. doi: 10.7507/1671-6205.2014038 復制

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.	張少雷,孫榮青.血管升壓藥物在感染性休克中的應用.中國呼吸與危重監護雜志,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.

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. 張少雷,孫榮青.血管升壓藥物在感染性休克中的應用.中國呼吸與危重監護雜志,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.

《中國呼吸與危重監護雜志》

去甲腎上腺素影響膿毒性休克被動抬腿試驗判斷液體反應性的臨床研究

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去甲腎上腺素影響膿毒性休克被動抬腿試驗判斷液體反應性的臨床研究

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