Hemodynamic effects of passive leg raising: an echocardiographic study in patients with shock
Hemodynamic effects of passive leg raising: an echocardiographic study in patients with shock
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DOI：
10.1007/s00134-008-1067-y
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发表时间：
2008-07-01
影响因子：
38.9
通讯作者：
Vieillard-Baron, Antoine
中科院分区：
文献类型：
--
作者：
Caille, Vincent;Jabot, Julien;Vieillard-Baron, Antoine
目的：根据上腔静脉塌陷指数 (Delta SVC) 定义的前负荷依赖性，确定被动抬腿 (PLR) 对血流动力学和心功能的影响。结果：纳入了 40 名休克、镇静且机械通气的患者。进行了经食管超声心动图检查。在基线 (T1) 时，根据 Delta SVC 定义两组。第 1 组有 18 名患者的 Delta SVC > 36%（前负荷依赖性指标），而 22 名患者（第 2 组）的 Delta SVC < 30%（不依赖于前负荷）。然后仅在第 1 组中在 PLR (T2)、回到基线 (T3) 和扩容后 (T4) 期间进行测量。在 T1 时，第 1 组的 Delta SVC 显着高于第 2 组，分别为 50 +/- 9% 和 7 +/- 6%。在第 1 组中，我们发现 T2 (24 ± 9%) 和 T4 (17 +/- 7%) 时的 SVC 下降，与收缩压、舒张压和动脉脉压增加相关。心脏指数也增加，从 1.92 +/- 0.74 (T1) 增加到 2.35 +/- 0.92 (T2) 和 2.85 +/- 1.21/min/m(2) (T4)，左心室舒张末期容积从 51 +/- 41 增加到 61 +/- 51 和 73 +/- 51 ml/m(2)。第 2 组中未发现这些变化。未观察到心率变化。结论：与 PLR 相关的血流动力学变化仅由心脏前负荷增加引起。
Objectives: To determine the effects of passive leg raising (PLR) on hemodynamics and on cardiac function according to the preload dependency defined by the superior vena cava collapsibility index (Delta SVC). Results: Forty patients with shock, sedated and mechanically ventilated, were included. Transesophageal echocardiography was performed. At baseline (T1), two groups were defined according to Delta SVC. Eighteen patients presenting a Delta SVC > 36%, an indicator of preload dependency, formed group 1, whereas 22 patients (group 2) exhibited a Delta SVC < 30% (not preload-dependent). Measurements were then performed during PLR (T2), back to baseline (T3), and after volume expansion (T4) in group 1 only. At T1, Delta SVC was significantly higher in group 1 than in group 2, 50 +/- 9% and 7 +/- 6%, respectively. In group 1, we found a decrease in. SVC at T2 (24 9%) and T4 (17 +/- 7%), associated with increased systolic, diastolic and arterial pulse pressures. Cardiac index also increased, from 1.92 +/- 0.74 (T1) to 2.35 +/- 0.92 (T2) and 2.85 +/- 1.21/min/m(2) (T4) and left ventricular end-diastolic volume from 51 +/- 41 to 61 +/- 51 and 73 +/- 51 ml/m(2). None of these variations was found in group 2. No change in heart rate was observed. Conclusion: Hemodynamic changes related to PLR were only induced by increased cardiac preload.