标题：被动抬腿试验预测液体复苏后心功能不全患者容量反应性的价值

      作者：张龙 1，邱淑华 2    (1.梅州市人民医院中山大学附属梅州医院外科重症监护室，广东 梅州 514000；2.中山大学附属第三医院粤东医院急诊科，广东 梅州 514000)

      卷次： 2018年29卷1期

      【摘要】 目的 探讨两种体位下被动抬腿试验(PLR)对液体复苏后心功能不全患者容量反应性的预测价值。方法 采用前瞻性、观察性队列研究方法，选取2016年1月至2017年3月在梅州市人民医院 ICU住院的52例液体复苏后并心功能不全的重症患者为研究对象。对患者依次行平卧位PLR、半卧位PLR和补液试验(VE)，用心阻抗无创血流动力学监测系统监测整个过程，记录基线、PLR和VE后心排血量(CO)、心率(HR)以及平均动脉压(MAP)等数据。根据VE后CO变化率(ΔCOVE)是否≥10%将患者分为有反应组和无反应组。分别对PLR和VE后ΔCO、ΔHR、ΔMAP进行相关性分析，采用ROC曲线评价两种体位下PLR对容量反应性的预测价值。结果 52例患者中有反应组27例，无反应组25例。PLR和VE时有反应组的ΔCO均明显大于无反应组[平卧位PLR：(11.17±3.36)% vs(4.14±7.17)%，t=4.469，P<0.01；半卧位PLR：(9.31±3.14)% vs (-4.14±10.55)%，t=6.147，P<0.01；VE：(13.79±2.35)% vs(0.84±7.16)%，t=8.620，P<0.01，且ΔCO PLR平卧、ΔCO PLR半卧均与ΔCOVE呈正相关(平卧位 r =0.737，半卧位 r=0.903，均P<0.01)。△CO PLR平卧、△CO PLR半卧预测患者容量反应性的ROC曲线下面积(AUC)分别为0.845、0.978，△CO PLR平卧预测容量反应性最佳临界值、灵敏度和特异度分别为8.7%、85.2%、76.0%，△CO PLR半卧预测容量反应性最佳临界值、灵敏度和特异度分别为5.9%、92.6%、96.0%。结论 两种体位下PLR均能准确预测液体复苏后心功能不全患者的容量反应性，且半卧位PLR优于平卧位PLR。
      【关键词】 被动抬腿试验；容量反应性；心功能不全；无创心排监测技术；液体复苏
      【中图分类号】 R54 【文献标识码】 A 【文章编号】 1003—6350（2018）1—0024—05V

alue of passive leg raising test in predicting volume responsiveness in patients with cardiac dysfunction afterfluid resuscitation.
ZHANG Long 1, QIU Shu-hua 2. 1. Department of Surgical Intensive Care Unit, Meizhou People'sHospital/Meizhou Affiliated Hospital of Sun Yat-sen University, Meizhou 514000, Guangdong, CHINA; 2. Department ofEmergency, the Third Affiliated Hospital of Sun Yat-sen University-Yuedong Hospital, Meizhou 514000, Guangdong, CHINA
【Abstract】 Objective To investigate the value of passive leg raising (PLR) test in two different postures in pre-dicting volume responsiveness in patients with cardiac dysfunction after fluid resuscitation. Methods A prospective ob-servational cohort study was conducted in ICU of Meizhou People's Hospital from January 2016 to March 2017. Fif-ty-two severe patients with cardiac dysfunction after fluid resuscitation were selected as the research subjects. A supinePLR test, a half-recumbent PLR trial, a final volume expansion test (VE) were conducted in-order for every patient. Im-pedance under monitoring of impedance cardiography throughout the process, the baseline data, cardiac output (CO),heart rate (HR), and mean arterial pressure (MAP) after PLR and VE were recorded. The patients were divided into reac-tive group and no response group according to whether the added value of CO (ΔCO) after VE was no less than 10%.·论 著·doi:10.3969/j.issn.1003-6350.2018.01.008基金项目：广东省梅州市医药卫生科研项目(编号：2016B63)