切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

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/OL]. 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/OL]. 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.

[1]
Durairaj L, SchmMt GA. Fluid therapy in resuscitated sepsis: less is more[J]. Chest, 2008, 133(1):252–263.
[2]
Monnet X, Teboul JL. Passive leg raising[J]. Intensive Care Med, 2008 34(6):659–663.
[3]
Sakka SG, Bredle DL, Reinhart K, et al. Comparison between intrathoracic blood volume and cardiac filling pressures in the early phase of hemodynamic instability of patients with sepsis or septic shock[J]. J Crit Care, 1999, 14(2):78–83.
[4]
Michard F, Alaya S, Zarka V, et al. Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock[J]. Chest, 2003, 124(5):1900–1908.
[5]
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.
[6]
成守宽. 心脏负荷增加时心排血功能起哪些变化, 怎样判断[J]. 中国临床医生, 1981, 10(2):21.
[7]
Antonelli M, Levy M, Andrews PJ, et al. Hemodynamic monitoring in shock and implications for management, internationalconsensus conference, Paris, France, 27-28 April 2006[J]. Intensive Care Med, 2007, 33(4):575–590
[8]
Osman D, Ridel C, Ray P, et al. Cardiac filling pressure are not appropriate to predict hemodynamic response to volume challenge[J]. Crit Care Med, 2007, 35(1):64–68.
[9]
Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness?A systematic review of the litera.ture and the tale of seven mares[J]. Chest, 2008, 134(1):172–178.
[10]
中华医学会重症医学分会. 成人严重感染与感染性休克血流动力学监测及支持指南(草案)[J]. 中国危重病急救医学, 2007, 19(3):129–133.
[11]
Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients:a critical analysis of the evidence[J]. Chest, 2002, 121(6):2000–2008.
[12]
Kramer A, Zygun D, Hawes H, et al. Pulse pressure variation predicts fluid responsiveness following coronary artery bypass surgery[J]. Chest, 2004, 126(5):1563–1568.
[13]
Thomas M, Shillingford J. The circulatory response to a standard postural change in ischaemic heart disease[J]. Br Heart J, 1965, 27:17–27.
[14]
Biais M, Vidil L, Sarrabay P, et al. Changes in stroke volume induced by passive leg raising in spontaneously breathing patients: comparison between echocardiography and Vigileo/FIoTrac device[J]. Crit Care, 2009, 13(6):195.
[15]
Thiel SW, Kollef MH, Isakow W. Non-invasive stroke volume measurement and passive leg raising predict volume responsiveness in medical ICU patients: an observational cohort study[J]. Crit Care, 2009, 13(4):111.
[16]
Préau S, Saulnier F, Dewavrin F, et al. Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis[J]. Crit Care Med, 2010, 38(3):819–825.
[17]
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.
[18]
Boulain T, Achard JM, Teboul JL, et al. Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients[J]. Chest, 2002, 121(4):1245–1252.
[19]
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.
[20]
Boulain T, Achard JM, Teboul JL, et al. Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients[J]. Chest, 2002, 121(4):1245–1252.
[21]
Guerin L, Monnet X, Teboul JL. Monitoring volume and fluid responsiveness: from static to dynamic indicators[J]. Best Pract Res Clin Anaesthesiol, 2013, 27(2):177–185.
[22]
Cavallaro F, Sandroni C, Marano C, et al. Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies[J]. Intensive Care Med, 2010, 36(9):1475–1483.
[23]
Monnet X, Teboul JL. Passive leg raising:five rules, not a drop of fluid![J]. Crit Care, 2015, 19(1):18.
[24]
Lakhal K, Ehrmann S, Runge I, et al. Central venous pressure measurements improve the accuracy of leg raising-induced change inpulse pressure to predict fluid responsiveness[J]. Intensive Care Med, 2010, 36(6):940–948.
[25]
Monnet X, Bataille A, Magalhaes E, et al. End-tidal carbon dioxide is better than arterial pressure for predicting volume responsiveness by the passive leg raising test[J]. Intensive Care Med, 2013, 39(1):93–100.
[26]
Bubenek-Turconi SI, Craciun M, Miclea I, et al. Noninvasive continuous cardiac output by the Nexfin before and after preload-modifying maneuvers: a comparison with intermittent thermodilution cardiac output[J]. Anesth Analg, 2013, 117(2):366–372.
[27]
Monge Garcia MI, Gil Cano A, Gracia Romero M, et al. Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO2 pressure during a passive leg-raising maneuver[J]. Ann Intensive Care, 2012, 2(9):1–10.
[28]
De Backer D, Pinsky MR. Can one predict fluid responsiveness in spontaneously breathing patients?[J]. Intensive Care Med, 2007, 33(7):1111–1113.
[29]
Mahjoub Y, Touzeau J, Airapetian N, et al. The passive leg-raising maneuver cannot accurately predict fluid responsiveness in patients with intra-abdominal hypertension[J]. Crit Care Med, 2010, 38(9):1824–1829.
[30]
Malbrain ML, Reuter DA. Assessing fluid responsiveness with the passive leg raising maneuver in patients with increased intra-abdominal pressure: be aware that not all blood returns![J]. Crit Care Med, 2010, 38(9):1912–1915.
[31]
Vincent JL, Weil MH. Fluid challenge revisited[J]. Crit Care Med, 2006, 34(5):1333–1337.
[1] 唐博, 罗季平, 周桃, 黄多, 刘廷琼, 陈亚萍, 岳文胜. 慢性肾衰竭血液透析患者造瘘侧上肢肱动脉-指端微小动脉血流动力学变化特点分析[J/OL]. 中华医学超声杂志(电子版), 2023, 20(12): 1276-1281.
[2] 李凤仪, 李若凡, 高旭, 张超凡. 目标导向液体干预对老年胃肠道肿瘤患者术后血流动力学、胃肠功能恢复的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(01): 29-32.
[3] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[4] 丁荷蓓, 王珣, 陈为国. 七氟烷吸入麻醉与异丙酚静脉麻醉在儿童腹股沟斜疝手术中的应用比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 570-574.
[5] 李先锋, 何懿, 程贞永, 邓国魁, 胡波, 谢红, 王莉, 王小燕, 李晓明. 右美托咪定对腹腔镜腹股沟疝修补术患者血流动力学及麻醉复苏效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 437-441.
[6] 郭建丽, 珠娜, 宋飞, 柴国东. 七氟烷吸入复合瑞芬太尼麻醉在小儿腹腔镜疝修补术中的效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 223-227.
[7] 彭敏敏, 杨晓斌, 芮亚楠. 羟考酮复合舒芬太尼在腹腔镜疝修补术中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 218-222.
[8] 潘忠军, 戎国祥, 丁明, 殷优宏, 张双龙. 非气管插管麻醉下单孔胸腔镜手术对肺结节及血流动力学、炎性指标的影响[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 272-275.
[9] 王守森, 傅世龙, 鲜亮, 林珑. 深入理解控制性减压技术对创伤性颅脑损伤术中脑膨出的预防机制与效果[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 257-262.
[10] 袁宝玉, 管义祥, 王东流, 陆正. 不同时机颅骨修补术治疗颅脑外伤的临床疗效[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(01): 35-41.
[11] 弥亮钰, 隆云. 心脏效率在血流动力学治疗中的研究进展[J/OL]. 中华重症医学电子杂志, 2024, 10(01): 72-78.
[12] 谢浩文, 丁建英, 刘小霞, 冯毅, 姚婧. 椎旁神经阻滞对微创胃切除肥胖患者术中血流、术后应激及康复质量的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 569-573.
[13] 袁琼, 李智珍, 黄少容, 孙玮萱. 腹腔镜下单侧输卵管开窗取胚术结合甲氨蝶呤对输卵管妊娠患者卵巢储备功能及血流动力学的影响[J/OL]. 中华临床医师杂志(电子版), 2023, 17(12): 1315-1319.
[14] 刘聪辉, 何浩然, 黄一诺, 张凤, 王凡月, 郝翰. 膳食铜补充对大鼠心肌梗死后心肌基质金属蛋白酶2表达水平及血流动力学的影响[J/OL]. 中华诊断学电子杂志, 2024, 12(03): 166-172.
[15] 芦乙滨, 李梦蝶, 许明. PDCA(计划、执行、检查和处理)循环教学在内科住院医师重症超声指导血流动力学评估培训中的效果评价[J/OL]. 中华卫生应急电子杂志, 2024, 10(04): 224-228.
阅读次数
全文


摘要