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find Keyword "被动抬腿试验" 3 results
  • The Influence of Norepinephrine on Prediction of Fluid Responsiveness by Passive Leg Raising during Septic Shock

    ObjectiveTo explore the influence of norepinephrine on the prediction of fluid responsiveness by passive leg raising (PLR) during septic shock. MethodsForty-six septic shock patients in intensive care unit of Nanjing Drum Tower Hospital were prospectively observed from September to November 2012. Among which 36 septic shock patients were enrolled with a positive PLR test (defined by an increase in stroke volume index ≥10%). A PLR test was performed at baseline (PLR1). A second PLR test (PLR2) was performed at returning to supine position for 10 min and the dose of norepinephrine was increased to maintain MAP ≥65 mmHg for 20 min. The changes of heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI),stroke volume index(SVI),index of systemic vascular resistance(SVRI),global end-diastolic volume index(GEDVI),and cardiac function index(CFI) were monitored by transpulmonary thermodilution technique (PiCCO). ResultsPLR1 significantly increased SVI by (20.54±9.63)%,CI by (20.57±9.89)%,MAP by (7.64±5.77)%,and CVP by (25.83±23.39)%. As the dose of norepinephrine increased,SVI was increased by (16.97±9.06)%,CI by (16.78±8.39)%,GEDVI by (9.08±4.47)%,MAP by (28.07±12.48)%,and CVP by (7.86±8.52)%. PLR2 increased SVI by (13.74±8.79)%,CI by (13.79±9.08)%,MAP by (2.93±5.06)%,and CVP by (13.36±14.74)%. The PLR2 and the dose increase of norepinephrine augmented SVI to a significantly lesser extent than the PLR1 performed at baseline (both P<0.05). However,SVI increased by <10% in 6 patients while the baseline PLR was positive in these patients. ConclusionIn septic patients with a positive PLR at baseline,norepinephrine increases cardiac preload and cardiac output and influences the fluid responsiveness.

    Release date:2016-08-30 11:31 Export PDF Favorites Scan
  • 被动抬腿试验预测容量反应性的最新研究进展

    在重症患者的循环支持中,容量状态的判断非常重要。静态指标及动态指标易受多种因素的影响,容量负荷试验安全性较差,在临床实施时均有一定局限性。被动抬腿试验预测容量反应性具有简单、快速、安全、受干扰小等特点,在不增加患者全身容量的基础上,可以迅速判断患者容量反应性。近年来将被动抬腿试验与其他血流动力学监测手段相结合,逐渐成为研究容量反应性的热点。

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  • 容量反应性研究进展

    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。

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