在重症医疗患者中,被动抬腿测试与快速液体挑战相比
Natascha Majunke1, Dan Philipp1, Lorenz Weidhase1
1Interdisziplinäre Internistische Intensivmedizin, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
Medizinische Klinik, Intensivmedizin und Notfallmedizin
|September 6, 2024
概括
被动腿部抬起 (PLR) 测试显示了与快速液体挑战 (RFC) 的中等一致性,用于评估血液动力学受损患者的预负载反应能力. 这一发现对于指导重症监护机构的流体管理策略至关重要.
科学领域:
- 关键护理医学 关键护理医学
- 血液动力学 血液动力学
- 心血管生理学心血管生理学
背景情况:
- 被动腿抬起 (PLR) 测试是评估预负载响应性的常用方法.
- 在此前评估PLR的研究中,已经注意到液体给药方案的变化.
- 已知流体挑战的血液动力学影响是暂时的,通常在10分钟内消散.
研究的目的:
- 为了前性地比较被动腿抬起 (PLR) 测试与快速液体挑战 (RFC) 的疗效,使用300毫升玻尿酸注入5分钟.
- 评估这些方法在经历血液动力学损害的成年患者.
主要方法:
- 这项研究包括了患有系统性低 perfusion 需要体积扩张的严重病情的医疗患者.
- 使用连续心脏输出 (CO) 和平均动脉压 (MAP) 测量来监测血液动力状况.
- 测量是在基线,PLR期间和RFC之后进行的.
主要成果:
- 包括124名患者,平均年龄为65.0岁; 73.3%患有败血症,79.8%接受了诺亚上腺素.
- 根据CO变化,PLR与RFC相比,虚假阳性和虚假阴性率分别为21.7%和36.8%.
- 根据MAP变化,PLR与RFC相比,虚假阳性和虚假阴性率分别为38.2%和43.3%.
结论:
- 在评估血液动力学受损医疗患者的预负载响应性方面,PLR和RFC之间存在温和的协议.
- 这些发现表明,在指导流体管理时,应谨慎考虑PLR的局限性.
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