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目的:高原地区被动抬腿试验(PLR)评估容量反应性的观察。方法:采用前瞻性自身对照的临床观察方法,选青海红十字医院重症医学科60例感染性休克患者,然后进行补液观察。采用无创心排血量监测(NICO)监测PLR前后血流动力学参数:心率、无创血压、心输出量(CO)、心脏指数(CI)、每搏输出量(SV)的变化。将补液后CO增加>10%定义为有液体反应性,CO增加<10%或未增加定义为无液体反应性,将患者分为有反应组和无反应组。两组对比观察高原地区PLR评估容量反应性的价值。结果:60例患者共进行80例次液体反应性观察,其中有液体反应性45例次,无液体反应性35例次。两组被动抬腿试验前后各指标变化中,有反应组患者CO、SV在被动抬腿试验后显著高于抬腿试验前,P<0.05。无反应组被动抬腿试验前后CO、SV无明显变化,P>0.05。无论有无液体反应性,被动抬腿试验前后心率、CVP、MAP无明显变化,P>0.05。结论:高原地区被动抬腿试验可以有效评估容量反应性,用以指导临床液体治疗。
OBJECTIVE: To observe the volume responsiveness of the passive leg lift test (PLR) in the plateau. Methods: A prospective, self-controlled clinical observation method was used to select 60 patients with septic shock in the Department of Critical Care Medicine of Qinghai Red Cross Hospital and then observed for rehydration. Noninvasive cardiac output monitoring (NICO) was used to monitor hemodynamic parameters before and after PLR: heart rate, noninvasive blood pressure, cardiac output (CO), cardiac index (CI) and stroke volume per patient (SV) A> 10% increase in CO after rehydration was defined as liquid reactivity, with <10% CO increase or no increase defined as non-liquid reactivity, and patients were divided into reactive and non-responsive groups. The two groups compared the value of platelet PLR assessment of volume responsiveness. Results: A total of 80 patients underwent liquid reactivity observation in 60 patients, including 45 cases of liquid reactivity and 35 cases of liquid reactivity. Before and after the passive leg raising test, the CO and SV of the responsive patients were significantly higher than those before the leg raising test (P <0.05). There was no significant change in CO, SV before and after passive leg-raising test in no-response group, P> 0.05. The heart rate, CVP and MAP did not change significantly before and after passive leg lift test with or without liquid reactivity, P> 0.05. CONCLUSION: Passive leg-raising test in plateau region can effectively assess volume responsiveness and guide clinical fluid therapy.