不同仪器测得的动态动脉弹性对感染性休克患者去甲肾上腺素减量后血压反应的预测价值

DynamicArterial Elastance Obtained from Two Independent Signals Can Predict the Blood Pressure Response after Norepinephrine Dosage Reduction in Patients with Septic Shock

摘要: 目的：探讨感染性休克患者，从两个不同仪器测量所获得的动态动脉弹性(Eadyn)是否可以预测去甲肾上腺素减量后的血压反应。方法：前瞻性分析2018.6~2019.8入住青岛大学附属医院ICU符合入选条件的患者36例。通过两种不同仪器测得Eadyn相关指标，分别为经胸彩色多普勒超声测量SVV，通过脉搏波形分析测得PPV，Eadyn = PPV/SVV。患者计划行去甲肾上腺素减量。根据去甲肾上腺素减量后平均动脉压(MAP)的变化，将患者分为MAP有反应组(MAP降低 ≥ 10%)和MAP无反应组(MAP降低 < 10%)，评价两组患者去甲肾上腺素减量后MAP变化的影响因素，Eadyn对去甲肾上腺素减量后MAP变化的预测价值。结果：Eadyn可以有效预测感染性休克患者去甲肾上腺素减量后MAP的变化，预测去甲肾上腺素减量后MAP降低的ROC曲线下面积为0.895，Eadyn ≤ 0.91的预测灵敏度95%，特异度75%。结论：从两个不同仪器获得的Eadyn可以预测感染性休克患者去甲肾减量后引起的MAP变化。

Abstract: Objective: To explore whether dynamic arterial elastance (Eadyn) obtained from two independent signals can predict the blood pressure response after norepinephrine dosage reduction in patients with septicshock. Methods: A prospective analysis of 2018.6-2019.8 patients admitted to the ICU of the Affiliated Hospital of Qingdao University was performed in 36 patients. Eadyn-related indicators were obtained by two independent signals, namely SVV by transthoracic color Doppler ultrasound, and PPV by pulse waveform analysis, Eadvn was defined as the ratio of pulse pressure variation (PPV) to stroke volume variation (SVV). According to the MAP changes after norepinephrine dosage reduction, patients were divided into MAP-responsive group (MAP decrease ≥ 10%) and MAP non-response group (MAP decrease < 10%) to evaluate the influencing factors of MAP changes after norepinephrine dosage reduction and to prove Eadyn’s predictive value of MAP changes after norepinephrine dosage reduction. Results: Eadyn was an effective predictor of MAP decrease after norepinephrine dosage reduction in patients with septic shock. The area under the ROC curve was 0.895. The baseline Eadyn value ≤ 0.91 predicted a decrease ≥ 10% in MAP after norepinephrine dosage reduction with a sensitivity of 95% and a specificity of 75%. Conclusion: Eadyn obtained from two different signals can predict MAP changes after norepinephrine dosage reduction in patients with septic shock.