中枢静脉氧和和中枢静脉与动脉二氧化碳张力差异的变化,以定义流体反应:一项前性观察性研究
Xiaoyang Zhou1, Hanyuan Fang2, Chang Xu1
1Department of Intensive Care Medicine, Ningbo No.2 Hospital, Ningbo, Zhejiang, China.
中枢静脉氧和度 (ΔScvO2) 和二氧化碳差异 (ΔP(cv-a) CO2) 的液体诱导的变化可以表明休克患者的液体反应. 它们的准确性在具有异常基线值或氧气消耗 (VO2) 不响应的患者中更好.
科学领域:
- 临界护理医学 临界护理医学
- 血液动力学 血液动力学
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 液体反应能力的评估对于有循环冲击的机械通风患者至关重要.
- 中枢静脉氧和度 (ΔScvO2) 和中枢静脉与动脉的二氧化碳张力差 [ΔP(cv-a) CO2] 变化是流体响应性的预测因素.
- 基线值和氧气消耗 (VO2) 响应对其诊断准确性的影响需要进行调查.
研究的目的:
- 评估液体诱导的 ΔScvO2 和 ΔP(cv-a) CO2 的诊断准确性,以预测液体反应.
- 为了确定基线ScvO2和P(cv-a) CO2值是否会影响这些流体响应预测器的准确性.
- 评估VO2响应对 ΔScvO2 和 ΔP(cv-a) CO2.2 的诊断性能的影响.
主要方法:
- 机械通风患者的前性观察性研究.
- 在流体挑战之前和之后,血液动力学和血液气体分析.
- 相关性和ROC曲线分析以评估诊断准确性,根据基线值和VO2响应能力进行子组分析.
主要成果:
- ΔScvO2 和 ΔP(cv-a) CO2 的变化与流体诱导的心脏指数的增加有显著的相关性.
- 流体反应的诊断准确度 (AUC) 为 ΔScvO2 的 0.76 和 ΔP(cv-a) CO2.CO 的 0.72.
- 在VO2无响应者 (AUC 0.91) 和基线ScvO2<70% (AUC 0.84) 的患者中, ΔScvO2的准确性得到改善.
结论:
- ΔScvO2 和 ΔP(cv-a) CO2 是液体在冲击中反应的潜在指标.
- 它们的预测值在具有异常基线值或VO2不响应的患者中得到增强.
- 这些参数为重症监护机构的流体管理策略提供了宝贵的见解.
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