容量反应性研究进展_West China Medical Journal

Authors：

 孟才华 ,  刘斌

四川大学华西医院麻醉科（成都 610041）;

Corresponding author：

刘斌, Email: liubinhx@foxmail.com

Keywords：

容量反应性; 每搏量变异度; 呼气末阻塞试验; 微容量负荷试验; 被动抬腿试验

DOI：

10.7507/1002-0179.20150396

Video：

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Abstract Full text Figures/Tables Video References Cited by

预测血流动力学不稳定患者对容量治疗的反应性仍然是临床上的一大挑战。不合适的容量治疗会对危重患者造成严重不良影响，因此在补充容量之前有必要首先确定患者的容量反应性情况。大量研究表明传统的静态前负荷指标如中心静脉压、肺毛细血管楔压等不能准确预测患者的容量反应性，而每搏量或其替代指标如脉搏压、由食管多普勒测量的主动脉血流、由经食管超声心动图测量的主动脉瓣下峰值流速以及由脉搏波形曲线分析估计的每搏量的呼吸变异度等可以准确地预测容量反应性，但是不适用于自主呼吸、心律失常、低潮气量或腹内压过高等情况，此时可以用呼气末阻塞试验、微容量负荷试验及被动抬腿试验等作为替代方法预测容量反应性，但是也有各自使用的局限性，需要根据临床具体情况选用相应合适的预测指标，进而更好地指导液体治疗。

Citation： 孟才华, 刘斌. 容量反应性研究进展. West China Medical Journal, 2015, 30(7): 1374-1377. doi: 10.7507/1002-0179.20150396 Copy

1.	Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy[J]. Ann Intensive Care, 2011, 12(1):308-316.
2.	Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units:results of the SOAP study[J]. Crit Care Med, 2006, 34(2):344-353.
3.	Boyd JH, Forbes J, Nakada TA, et al. Fluid resuscitation in septic shock:a positive fluid balance and elevated central venous pressure are associated with increased mortality[J]. Crit Care Med, 2011, 39(2):259-265.
4.	National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury[J]. N Engl J Med, 2006, 354(24):2564-2575.
5.	Sakka SG, Klein M, Reinhart K, et al. Prognostic value of extravascular lung water in critically ill patients[J]. Chest, 2002, 122(6):2080-2086.
6.	Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients:a critical analysis of the evidence[J]. Chest, 2002, 121(6):2000-2008.
7.	Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares[J]. Chest, 2008, 134(1):172-178.
8.	Michard F, Teboul JL. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation[J]. Crit Care, 2000, 4(5):282-289.
9.	Cannesson M, Musard H, Desebbe O, et al. The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients[J]. Anesth Analg, 2009, 108(2):513-517.
10.	Pinsky MR, Payen D. Functional hemodynamic monitoring[J]. Crit Care, 2005, 9(6):566-572.
11.	Marx G, Cope T, Mccrossan L, et al. Assessing fluid responsiveness by stroke volume variation in mechanically ventilated patients with severe sepsis[J]. Eur J Anaesthesiol, 2004, 21(2):132-138.
12.	Reuter DA, Kirchner A, Felbinger TW, et al. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function[J]. Crit Care Med, 2003, 31(5):1399-1404.
13.	Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients:a systematic review of the literature[J]. Crit Care Med, 2009, 37(9):2642-2647.
14.	Monnet X, Rienzo M, Osman D, et al. Esophageal doppler monitoring predicts fluid responsiveness in critically ill ventilated patients[J]. Intensive Care Med, 2005, 31(9):1195-1201.
15.	Feissel M, Michard F, Mangin I, et al. Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock[J]. Chest, 2001, 119(3):867-873.
16.	Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery[J]. Anesth Analg, 2001, 92(4):984-989.
17.	Sandroni C, Cavallaro F, Marano C, et al. Accuracy of plethysmographic indices as predictors of fluid responsiveness in mechanically ventilated adults:a systematic review and metaanalysis[J]. Intensive Care Med, 2012, 38(9):1429-1437.
18.	Feissel M, Michard F, Faller JP, et al. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy[J]. Intensive Care Med, 2004, 30(9):1834-1837.
19.	Vieillard-Baron A, Chergui K, Rabiller A, et al. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients[J]. Intensive Care Med, 2004, 30(9):1734-1739.
20.	Teboul JL, Monnet X. Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity[J]. Curr Opin Crit Care, 2008, 14(3):334-339.
21.	Heenen S, De Backer D, Vincent JL. How can the response to volume expansion in patients with spontaneous respiratory movements be predicted?[J]. Crit Care, 2006, 10(4):R102.
22.	Monnet X, Rienzo M, Osman D, et al. Passive leg raising predicts fluid responsiveness in the critically ill[J]. Crit Care Med, 2006, 34(5):1402-1407.
23.	Soubrier S, Saulnier F, Hubert H, et al. Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients?[J]. Intensive Care Med, 2007, 33(7):1117-1124.
24.	De Backer D, Heenen S, Piagnerelli M, et al. Pulse pressure variations to predict fluid responsiveness:influence of tidal volume[J]. Intensive Care Med, 2005, 31(4):517-523.
25.	Muller L, Louart G, Bousquet PJ, et al. The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness[J]. Intensive Care Med, 2010, 36(3):496-503.
26.	De Backer D, Taccone FS, Holsten R, et al. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients[J]. Anesthesiology, 2009, 110(5):1092-1097.
27.	Tavemier B, Robin E. Assessment of fluid responsiveness during increased intra-abdominal pressure:keep the indices, but change the thresholds[J]. Crit Care, 2011, 15(2):134.
28.	De Waal EE, Rex S, Kruitwagen CL, et al. Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions[J]. Crit Care Med, 2009, 37(2):510-515.
29.	Monnet X, Osman D, Ridel C, et al. Predicting volume responsiveness by using the end-expiratory occlusion in mechanically ventilated intensive care unit patients[J]. Crit Care Med, 2009, 37(3):951-956.
30.	Monnet X, Bleibtreu A, Ferré A, et al. Passive leg-raising and endexpiratory occlusion tests perform better than pulse pressure variation in patients with low respiratory system compliance[J]. Crit Care Med, 2012, 40(1):152-157.
31.	Vincent JL, Weil MH. Fluid challenge revisited[J]. Crit Care Med, 2006, 34(5):1333-1337.
32.	Muller L, Toumi M, Bousquet PJ, et al. An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness:the mini-fluid challenge study[J]. Anesthesiology, 2011, 115(3):541-547.
33.	Monnet X, Teboul JL. Passive leg raising[J]. Intensive Care Med, 2008, 34(4):659-663.
34.	Jabot J, Teboul JL, Richard C, et al. Passive leg raising for predicting fluid responsiveness:importance of the postural change[J]. Intensive Care Med, 2009, 35(1):85-90.
35.	Biais M, Vidil L, Sarrabay P, et al. Changes in stroke volume induced by passive leg raising in spontaneously breathing patients:comparison between echocardiograph and Vigileo/FIoTrac device[J]. Crit Care, 2009, 13(6):R195.
36.	Delerme S, Renault R, Le Manach Y, et al. Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers[J]. Am J Emerg Med, 2007, 25(6):637-642.

1. Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy[J]. Ann Intensive Care, 2011, 12(1):308-316.
2. Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units:results of the SOAP study[J]. Crit Care Med, 2006, 34(2):344-353.
3. Boyd JH, Forbes J, Nakada TA, et al. Fluid resuscitation in septic shock:a positive fluid balance and elevated central venous pressure are associated with increased mortality[J]. Crit Care Med, 2011, 39(2):259-265.
4. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury[J]. N Engl J Med, 2006, 354(24):2564-2575.
5. Sakka SG, Klein M, Reinhart K, et al. Prognostic value of extravascular lung water in critically ill patients[J]. Chest, 2002, 122(6):2080-2086.
6. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients:a critical analysis of the evidence[J]. Chest, 2002, 121(6):2000-2008.
7. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares[J]. Chest, 2008, 134(1):172-178.
8. Michard F, Teboul JL. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation[J]. Crit Care, 2000, 4(5):282-289.
9. Cannesson M, Musard H, Desebbe O, et al. The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients[J]. Anesth Analg, 2009, 108(2):513-517.
10. Pinsky MR, Payen D. Functional hemodynamic monitoring[J]. Crit Care, 2005, 9(6):566-572.
11. Marx G, Cope T, Mccrossan L, et al. Assessing fluid responsiveness by stroke volume variation in mechanically ventilated patients with severe sepsis[J]. Eur J Anaesthesiol, 2004, 21(2):132-138.
12. Reuter DA, Kirchner A, Felbinger TW, et al. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function[J]. Crit Care Med, 2003, 31(5):1399-1404.
13. Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients:a systematic review of the literature[J]. Crit Care Med, 2009, 37(9):2642-2647.
14. Monnet X, Rienzo M, Osman D, et al. Esophageal doppler monitoring predicts fluid responsiveness in critically ill ventilated patients[J]. Intensive Care Med, 2005, 31(9):1195-1201.
15. Feissel M, Michard F, Mangin I, et al. Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock[J]. Chest, 2001, 119(3):867-873.
16. Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery[J]. Anesth Analg, 2001, 92(4):984-989.
17. Sandroni C, Cavallaro F, Marano C, et al. Accuracy of plethysmographic indices as predictors of fluid responsiveness in mechanically ventilated adults:a systematic review and metaanalysis[J]. Intensive Care Med, 2012, 38(9):1429-1437.
18. Feissel M, Michard F, Faller JP, et al. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy[J]. Intensive Care Med, 2004, 30(9):1834-1837.
19. Vieillard-Baron A, Chergui K, Rabiller A, et al. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients[J]. Intensive Care Med, 2004, 30(9):1734-1739.
20. Teboul JL, Monnet X. Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity[J]. Curr Opin Crit Care, 2008, 14(3):334-339.
21. Heenen S, De Backer D, Vincent JL. How can the response to volume expansion in patients with spontaneous respiratory movements be predicted?[J]. Crit Care, 2006, 10(4):R102.
22. Monnet X, Rienzo M, Osman D, et al. Passive leg raising predicts fluid responsiveness in the critically ill[J]. Crit Care Med, 2006, 34(5):1402-1407.
23. Soubrier S, Saulnier F, Hubert H, et al. Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients?[J]. Intensive Care Med, 2007, 33(7):1117-1124.
24. De Backer D, Heenen S, Piagnerelli M, et al. Pulse pressure variations to predict fluid responsiveness:influence of tidal volume[J]. Intensive Care Med, 2005, 31(4):517-523.
25. Muller L, Louart G, Bousquet PJ, et al. The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness[J]. Intensive Care Med, 2010, 36(3):496-503.
26. De Backer D, Taccone FS, Holsten R, et al. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients[J]. Anesthesiology, 2009, 110(5):1092-1097.
27. Tavemier B, Robin E. Assessment of fluid responsiveness during increased intra-abdominal pressure:keep the indices, but change the thresholds[J]. Crit Care, 2011, 15(2):134.
28. De Waal EE, Rex S, Kruitwagen CL, et al. Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions[J]. Crit Care Med, 2009, 37(2):510-515.
29. Monnet X, Osman D, Ridel C, et al. Predicting volume responsiveness by using the end-expiratory occlusion in mechanically ventilated intensive care unit patients[J]. Crit Care Med, 2009, 37(3):951-956.
30. Monnet X, Bleibtreu A, Ferré A, et al. Passive leg-raising and endexpiratory occlusion tests perform better than pulse pressure variation in patients with low respiratory system compliance[J]. Crit Care Med, 2012, 40(1):152-157.
31. Vincent JL, Weil MH. Fluid challenge revisited[J]. Crit Care Med, 2006, 34(5):1333-1337.
32. Muller L, Toumi M, Bousquet PJ, et al. An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness:the mini-fluid challenge study[J]. Anesthesiology, 2011, 115(3):541-547.
33. Monnet X, Teboul JL. Passive leg raising[J]. Intensive Care Med, 2008, 34(4):659-663.
34. Jabot J, Teboul JL, Richard C, et al. Passive leg raising for predicting fluid responsiveness:importance of the postural change[J]. Intensive Care Med, 2009, 35(1):85-90.
35. Biais M, Vidil L, Sarrabay P, et al. Changes in stroke volume induced by passive leg raising in spontaneously breathing patients:comparison between echocardiograph and Vigileo/FIoTrac device[J]. Crit Care, 2009, 13(6):R195.
36. Delerme S, Renault R, Le Manach Y, et al. Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers[J]. Am J Emerg Med, 2007, 25(6):637-642.

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