颈总动脉血流监测在成人脓毒症休克患者液体复苏中的应用

余哲; 祖晨晨; 盛世争; 李刚

doi:10.16766/j.cnki.issn.1674-4152.003914

颈总动脉血流监测在成人脓毒症休克患者液体复苏中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003914

余哲¹,
祖晨晨¹,
盛世争^2, ,,
李刚³

1.
浙江省人民医院淳安分院急诊医学科，浙江杭州 311700
2.
舟山市定海区中心医院急诊科，浙江舟山 316000
3.
浙江中医药大学附属第三医院急诊科，浙江杭州 310005

基金项目:

浙江省中医药科技计划项目 2024ZL528

详细信息

通讯作者:
盛世争，E-mail：278750193@qq.com

中图分类号: R631
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- 文章访问数: 6
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- 被引次数: 0
出版历程
- 收稿日期: 2024-02-10
- 网络出版日期: 2025-05-14

Application of common carotid artery blood flow monitoring in fluid resuscitation of adult patients with septic shock

1.
Department of Emergency Medicine, Chun' an Branch of Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 311700, China

摘要

摘要: 目的监测脓毒症休克患者颈总动脉流速，并分析颈总动脉血流变异性与液体复苏效果的相关性。方法以浙江省人民医院淳安分院2020年8月—2023年6月期间收治的107例脓毒症休克患者为研究对象。液体复苏前、后根据心脏每搏指数(SVI)变化率(ΔSVI)分为2组，ΔSVI < 10%为无反应组(42例)，ΔSVI≥10%为有反应组(65例)。比较2组一般资料、超声参数。采用多因素logistic回归分析研究影响液体复苏效果的因素；采用ROC曲线分析评估颈总动脉血流变异性预测液体复苏效果的价值。结果反应组被动抬腿试验前后速度时间积分差值(ΔVTI)、校正血流时间差值(ΔFTc)、颈总动脉峰值流速度变异率(ΔVpeakCA)、下腔静脉呼吸变异率(ΔIVC)以及主动脉峰值流速呼吸变异率(ΔVpeakAo)均高于无反应组(P<0.05)；多因素logistic回归结果显示，ΔVTI(OR=1.087，95% CI：0.009~0.876)、ΔFTc(OR=1.499，95% CI：1.013~2.219)、ΔVpeakCA(OR=1.555，95% CI：1.071~2.256)、ΔIVC(OR=2.427，95% CI：1.060~5.554)是影响液体复苏效果的因素(P<0.05)。ROC曲线显示，ΔVTI、ΔFTc、ΔVpeakCA、ΔIVC联合预测的AUC(0.969)显著高于ΔVTI(0.833)、ΔFTc(0.648)、ΔVpeakCA(0.886)、ΔIVC(0.596)单独预测。结论颈总动脉血流变异性是影响脓毒症休克患者液体复苏的因素，且ΔVpeakCA对患者的评估价值较高。
- 脓毒症休克 /
- 液体复苏 /
- 颈动脉流速变异性 /
- 影响因素 /
- 相关性
Abstract: Objective To monitor the velocity of common carotid artery in septic shock patients, and analyze the correlation between the variability of common carotid artery blood flow and the effect of fluid resuscitation. Methods A total of 107 patients with septic shock admitted to Chun ' an Branch of Zhejiang Provincial People ' s Hospital from August 2020 to June 2023 were taken as the research object. Before and after fluid resuscitation, they were divided into two groups according to the rising rate (ΔSVI) of cardiac stroke index (SVI). ΔSVI < 10% was non-response group (42 cases) and ΔSVI≥10% was response group (65 cases). The general data and ultrasonic parameters of the two groups were compared. Multivariate logistic regression was used to analyze the factors affecting the effect of liquid resuscitation. The value of ROC and AUC analysis of common carotid artery blood flow variability was used to evaluate the effect of fluid resuscitation. Results ΔASVI, velocity-time integral difference before and after passive leg raising test (ΔVTI), corrected blood flow time difference (ΔFTc), variation rate of common carotid artery peak flow velocity (ΔVpeakCA), respiratory variation rate of inferior vena cava (ΔIVC) and respiratory variation rate of aortic peak flow velocity (ΔVpeakAo) in the occurrence group were lower than those in the non-occurrence group, and the difference was statistically significant (P<0.05). Multivariate logistic regression results showed that ΔVTI (OR=1.087, 95% CI: 0.009-0.876), ΔFTc (OR=1.499, 95% CI: 1.013-2.219), ΔVpeakCA (OR=1.555, 95% CI: 1.071-2.256) and ΔIVC(OR=2.427, 95% CI: 1.060-5.554) were factors influencing the effectiveness of fluid resuscitation (P<0.05). ROC curve showed that the AUC of the combination of ΔVTI, ΔFTc, ΔVpeakCA and ΔIVC (0.969) was significantly higher than that of ΔVTI (0.833), ΔFTc (0.648), ΔVpeakCA (0.886) and ΔIVC (0.596). Conclusion The variability of common carotid artery blood flow is a factor affecting fluid resuscitation in patients with septic shock, and ΔVpeakCA has high evaluation value for patients.
- Septic shock /
- Liquid resuscitation /
- Variability of carotid artery velocity at the end of respiration /
- Influencing factors /
- Correlation

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图 1 颈总动脉血流变异性与液体复苏效果相关性的ROC曲线

Figure 1. ROC curve for the association of common carotid artery hemorheology with the effect of fluid resuscitation

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表 1 2组脓毒症休克患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with septic shock

项目	反应组(n=65)	无反应组(n=42)	统计量	P值
年龄(x±s，岁)	59.35±18.26	62.04±15.61	1.062^a	0.290
性别(男性/女性，例)	39/26	27/15	0.198^b	0.656
BMI(x±s)	23.26±2.51	22.48±3.83	1.168^a	0.247
APACHEⅡ评分(x±s，分)	30.25±5.64	31.97±6.38	1.424^a	0.158
原发病构成[例(%)]
高血压	24(36.92)	17(40.48)	0.136^b	0.712
糖尿病	18(27.69)	12(28.57)	0.009^b	0.921
冠心病	10(15.38)	6(14.29)	0.024^b	0.876
慢阻肺	12(18.46)	8(19.05)	2.818^b	0.932
原发感染部位[例(%)]			0.390^b	0.942
肺部感染	24(36.92)	18(42.86)
腹腔感染	20(30.77)	2(4.76)
泌尿系感染	12(18.46)	7(16.67)
血流感染	9(13.85)	5(11.90)
注：^a为t值，^b为x²值。

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表 2 2组脓毒症休克患者颈总动脉流速变异性比较(x±s)

Table 2. Comparison of common carotid artery flow velocity variability between the two groups of patients with septic shock (x±s)

组别	例数	ΔVTI (cm)	ΔFTc (ms)	ΔVpeakCA (%)	ΔIVC (%)	ΔVpeakAo (%)
反应组	65	2.25±0.74	3.81±1.27	15.61±5.33	16.21±5.24	15.31±4.87
无反应组	42	0.94±0.27	2.12±0.65	7.48±2.42	13.54±4.64	12.49±3.36
t值		11.009	9.050	10.708	2.761	3.543
P值		< 0.001	< 0.001	< 0.001	0.007	0.001

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表 3 各变量赋值情况

Table 3. Assignment of variables

变量	赋值方法
ΔVTI	以实际值赋值
ΔFTc	以实际值赋值
ΔVpeakCA	以实际值赋值
ΔIVC	以实际值赋值
ΔVpeakAo	以实际值赋值
液体复苏反应性	有反应=1，无反应=0

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表 4 影响脓毒症休克患者液体复苏效果的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of the effect of fluid resuscitation in patients with septic shock

变量	B	SE	Waldχ²	P值	OR值	95% CI
ΔVTI	2.441	1.178	4.295	0.038	1.087	0.009~0.876
ΔFTc	0.405	0.200	4.098	0.043	1.499	1.013~2.219
ΔVpeakCA	0.441	0.190	5.399	0.020	1.555	1.071~2.256
ΔIVC	0.886	0.423	4.402	0.036	2.427	1.060~5.554
ΔVpeakAo	0.041	0.123	0.111	0.739	1.042	0.819~1.325

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表 5 颈总动脉血流变异性与液体复苏效果的相关性

Table 5. Correlation between blood rheological variability of the common carotid artery and the effect of fluid resuscitation

变量	AUC	95% CI	SE	P值
△FTc	0.648	0.549~0.738	0.041	0.039
△IVC	0.596	0.497~0.690	0.049	0.012
△VTI	0.833	0.748~0.898	0.039	0.023
△VpeakCA	0.886	0.811~0.940	0.034	0.041
联合	0.969	0.916~0.993	0.012	0.044

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