通过被动腿抬高测试诱导的CO2衍生变量的变化,检测机械通风患者的预负载响应:试点研究
Angeliki Baladima1,2, Stelios Kokkoris1, Dimitrios Tzalas2
1First Department of Critical Care Medicine and Pulmonary Services, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, 45-47 Ipsilantou Street, 106 76 Athens, Greece.
被动腿部提升 (PLR) 可以通过监测中央静脉动脉二氧化碳部分压力 (P(cv-a) CO2) 的变化来评估液体反应. 在PLR期间P(cv-a) CO2的下降表明重症患者的预负载响应.
科学领域:
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
- 血液动力学监测 血液动力学监测
背景情况:
- 在重症患者中,评估液体反应能力至关重要.
- 二氧化碳衍生变量是流体响应性的潜在标志物.
- 被动腿部提升 (PLR) 是一种非侵入性方法,用于评估预负载响应能力.
研究的目的:
- 调查PLR诱导的CO2衍生变量的变化是否可以检测预加载响应.
- 评估中心静脉动脉二氧化碳部分压力 (P(cv-a) CO2) 和P(cv-a) CO2/C(a-cv) O2比率作为标记.
主要方法:
- 30名急性循环衰竭的机械呼吸患者接受了PLR测试.
- 测量了血液动力学变量,左心室外流通道速度与时间积分 (VTI) 和二氧化碳衍生变量.
- 预加载响应被定义为PLR期间VTI增加≥10%.
主要成果:
- 50%的患者在预加载时有反应.
- 在P(cv-a) CO2和P(cv-a) CO2/C(a-cv) O2的变化与VTI变化相关,并且在响应者和非响应者之间存在显著差异.
- 一个PLR诱导的P(cv-a) CO2的下降显著与预加载响应 (AUC 0.89) 相关.
结论:
- 在P(cv-a) CO2和P(cv-a) CO2/C(a-cv) O2中PLR诱导的变化与机械通风ICU患者的VTI变化相关.
- 在P(cv-a) CO2的变化有效地检测了PLR评估的预加载响应.
- P(cv-a) CO2可以作为一个间接标记指导液体复苏,当心脏输出测量是不可行的.
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