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中华重症医学电子杂志 ›› 2016, Vol. 02 ›› Issue (01) : 63 -67. doi: 10.3877/cma.j.jssn.2096-1537.2016.01.014

所属专题: 文献

综述

被动抬腿试验在容量复苏管理中的价值
付江泉1, 王迪芬1,*,*()   
  1. 1. 550004 贵阳,贵州医科大学附属医院重症医学科
  • 收稿日期:2015-11-17 出版日期:2016-02-28
  • 通信作者: 王迪芬
  • 基金资助:
    2011年国家临床重点专科建设项目(财社[2011]170号); 2011年贵州省临床重点学科建设项目(黔卫办发[2011]52号); 贵州省科技攻关项目(黔科合SY[2010]3079号); 贵州省高层次人才特助经费项目(TZJF-2011年-25号); 中华医学会临床医学科研专项基金-国瑞重症科研项目(13091490534)

Passive leg raising test in volume resuscitation

Jiangquan Fu1, Difen Wang1()   

  1. 1. Department of Intensive Care Unit, Affiliated Hospital of Guizhou medical university, guiyang 550004, China
  • Received:2015-11-17 Published:2016-02-28
  • Corresponding author: Difen Wang
  • About author:
    Corresponding author: Wang Difen, Email:
引用本文:

付江泉, 王迪芬. 被动抬腿试验在容量复苏管理中的价值[J]. 中华重症医学电子杂志, 2016, 02(01): 63-67.

Jiangquan Fu, Difen Wang. Passive leg raising test in volume resuscitation[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(01): 63-67.

被动抬腿试验(PLR)是预测容量反应性的一种新方法。在初始的重症监护室(ICU)复苏后,液体过负荷对危重病患者是有害的,ICU患者需要一些方法帮助判断容量反应性的情况。现已明确静态前负荷指标的无法有效预测液体反应性,动态前负荷指标则可达到这一目的。比如每搏量变异率(SVV)和脉压变异率(PPV)等具有较好的效果,但它们不能用于自主呼吸活动、心律失常、小潮气量或低肺顺应的患者。PLR可解决上述PPV等指标解决不了的问题。PLR是预测容量反应性的一种新方法,通过监测被动抬腿试验诱导的心搏量或其替代指标的变化大小来预测机体的容量反应性,是功能性血流动力学监测指标,是可逆的自体容量负荷试验。该试验能够精确预测容量反应性,并具有操作简单、安全性高、不受自主呼吸和心律失常干扰、不受监测设备限制的优点,值得在临床上推广应用,指导液体治疗。

Passive leg raising(PLR) is a new method for predicting volume responsiveness. Growing evidence suggests that overzealous fluid administration is deleterious in critically ill patients, particularly in those with sepsis after initial resuscitation in ICUs. Detecting preload respondents or preload non-respondents is an important issue in critically ill patients in order to differentiate patients who can be benefited from volume expansion and those who cannot, thus avoiding in the latter volume overload. It is demonstrated that statistical indicators of preload cannot predict fluid responsiveness in contrast to dynamic tests. The analysis of respiratory variation of stroke volume and surrogates such as PPV has shown abundant evidence that cannot be used in cases of spontaneous breathing activity, cardiac arrhythmia, low tidal volume or low lung compliance. PLR can solve the problem in predicting fluid responsiveness when PPV cannot be interpreted appropriately. Volume responsiveness is predicted by the changes in stroke volume or its surrogates induced by PLR. PLR, taken as a reversible"self-volume challenge", is a functional hemodynamic parameter. It can be used to predict volume responsiveness accurately. PLR has the advantages of simple operation, high safety, not disturbed by spontaneous breathing or arrhythmia and not restricted by monitoring equipments. It should be used to guide fluid therapy in clinical practice.

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