容量反應性研究進展_West China Medical Journal

Authors：

 孟才華 ,  劉斌

四川大學華西醫院麻醉科（成都 610041）;

Corresponding?author：

劉斌, Email: liubinhx@foxmail.com

Keywords：

容量反應性; 每搏量變異度; 呼氣末阻塞試驗; 微容量負荷試驗; 被動抬腿試驗

DOI：

10.7507/1002-0179.20150396

Video：

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Abstract Full text Figures/Tables Video References Cited by

預測血流動力學不穩定患者對容量治療的反應性仍然是臨床上的一大挑戰。不合適的容量治療會對危重患者造成嚴重不良影響，因此在補充容量之前有必要首先確定患者的容量反應性情況。大量研究表明傳統的靜態前負荷指標如中心靜脈壓、肺毛細血管楔壓等不能準確預測患者的容量反應性，而每搏量或其替代指標如脈搏壓、由食管多普勒測量的主動脈血流、由經食管超聲心動圖測量的主動脈瓣下峰值流速以及由脈搏波形曲線分析估計的每搏量的呼吸變異度等可以準確地預測容量反應性，但是不適用于自主呼吸、心律失常、低潮氣量或腹內壓過高等情況，此時可以用呼氣末阻塞試驗、微容量負荷試驗及被動抬腿試驗等作為替代方法預測容量反應性，但是也有各自使用的局限性，需要根據臨床具體情況選用相應合適的預測指標，進而更好地指導液體治療。

Citation： 孟才華, 劉斌. 容量反應性研究進展. West China Medical Journal, 2015, 30(7): 1374-1377. doi: 10.7507/1002-0179.20150396 Copy

1.	Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy[J]. Ann Intensive Care, 2011, 12(1):308-316.
2.	Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units:results of the SOAP study[J]. Crit Care Med, 2006, 34(2):344-353.
3.	Boyd JH, Forbes J, Nakada TA, et al. Fluid resuscitation in septic shock:a positive fluid balance and elevated central venous pressure are associated with increased mortality[J]. Crit Care Med, 2011, 39(2):259-265.
4.	National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury[J]. N Engl J Med, 2006, 354(24):2564-2575.
5.	Sakka SG, Klein M, Reinhart K, et al. Prognostic value of extravascular lung water in critically ill patients[J]. Chest, 2002, 122(6):2080-2086.
6.	Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients:a critical analysis of the evidence[J]. Chest, 2002, 121(6):2000-2008.
7.	Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares[J]. Chest, 2008, 134(1):172-178.
8.	Michard F, Teboul JL. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation[J]. Crit Care, 2000, 4(5):282-289.
9.	Cannesson M, Musard H, Desebbe O, et al. The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients[J]. Anesth Analg, 2009, 108(2):513-517.
10.	Pinsky MR, Payen D. Functional hemodynamic monitoring[J]. Crit Care, 2005, 9(6):566-572.
11.	Marx G, Cope T, Mccrossan L, et al. Assessing fluid responsiveness by stroke volume variation in mechanically ventilated patients with severe sepsis[J]. Eur J Anaesthesiol, 2004, 21(2):132-138.
12.	Reuter DA, Kirchner A, Felbinger TW, et al. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function[J]. Crit Care Med, 2003, 31(5):1399-1404.
13.	Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients:a systematic review of the literature[J]. Crit Care Med, 2009, 37(9):2642-2647.
14.	Monnet X, Rienzo M, Osman D, et al. Esophageal doppler monitoring predicts fluid responsiveness in critically ill ventilated patients[J]. Intensive Care Med, 2005, 31(9):1195-1201.
15.	Feissel M, Michard F, Mangin I, et al. Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock[J]. Chest, 2001, 119(3):867-873.
16.	Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery[J]. Anesth Analg, 2001, 92(4):984-989.
17.	Sandroni C, Cavallaro F, Marano C, et al. Accuracy of plethysmographic indices as predictors of fluid responsiveness in mechanically ventilated adults:a systematic review and metaanalysis[J]. Intensive Care Med, 2012, 38(9):1429-1437.
18.	Feissel M, Michard F, Faller JP, et al. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy[J]. Intensive Care Med, 2004, 30(9):1834-1837.
19.	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.
20.	Teboul JL, Monnet X. Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity[J]. Curr Opin Crit Care, 2008, 14(3):334-339.
21.	Heenen S, De Backer D, Vincent JL. How can the response to volume expansion in patients with spontaneous respiratory movements be predicted?[J]. Crit Care, 2006, 10(4):R102.
22.	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.
23.	Soubrier S, Saulnier F, Hubert H, et al. Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients?[J]. Intensive Care Med, 2007, 33(7):1117-1124.
24.	De Backer D, Heenen S, Piagnerelli M, et al. Pulse pressure variations to predict fluid responsiveness:influence of tidal volume[J]. Intensive Care Med, 2005, 31(4):517-523.
25.	Muller L, Louart G, Bousquet PJ, et al. The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness[J]. Intensive Care Med, 2010, 36(3):496-503.
26.	De Backer D, Taccone FS, Holsten R, et al. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients[J]. Anesthesiology, 2009, 110(5):1092-1097.
27.	Tavemier B, Robin E. Assessment of fluid responsiveness during increased intra-abdominal pressure:keep the indices, but change the thresholds[J]. Crit Care, 2011, 15(2):134.
28.	De Waal EE, Rex S, Kruitwagen CL, et al. Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions[J]. Crit Care Med, 2009, 37(2):510-515.
29.	Monnet X, Osman D, Ridel C, et al. Predicting volume responsiveness by using the end-expiratory occlusion in mechanically ventilated intensive care unit patients[J]. Crit Care Med, 2009, 37(3):951-956.
30.	Monnet X, Bleibtreu A, Ferré A, et al. Passive leg-raising and endexpiratory occlusion tests perform better than pulse pressure variation in patients with low respiratory system compliance[J]. Crit Care Med, 2012, 40(1):152-157.
31.	Vincent JL, Weil MH. Fluid challenge revisited[J]. Crit Care Med, 2006, 34(5):1333-1337.
32.	Muller L, Toumi M, Bousquet PJ, et al. An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness:the mini-fluid challenge study[J]. Anesthesiology, 2011, 115(3):541-547.
33.	Monnet X, Teboul JL. Passive leg raising[J]. Intensive Care Med, 2008, 34(4):659-663.
34.	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.
35.	Biais M, Vidil L, Sarrabay P, et al. Changes in stroke volume induced by passive leg raising in spontaneously breathing patients:comparison between echocardiograph and Vigileo/FIoTrac device[J]. Crit Care, 2009, 13(6):R195.
36.	Delerme S, Renault R, Le Manach Y, et al. Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers[J]. Am J Emerg Med, 2007, 25(6):637-642.

1. Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy[J]. Ann Intensive Care, 2011, 12(1):308-316.
2. Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units:results of the SOAP study[J]. Crit Care Med, 2006, 34(2):344-353.
3. Boyd JH, Forbes J, Nakada TA, et al. Fluid resuscitation in septic shock:a positive fluid balance and elevated central venous pressure are associated with increased mortality[J]. Crit Care Med, 2011, 39(2):259-265.
4. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury[J]. N Engl J Med, 2006, 354(24):2564-2575.
5. Sakka SG, Klein M, Reinhart K, et al. Prognostic value of extravascular lung water in critically ill patients[J]. Chest, 2002, 122(6):2080-2086.
6. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients:a critical analysis of the evidence[J]. Chest, 2002, 121(6):2000-2008.
7. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares[J]. Chest, 2008, 134(1):172-178.
8. Michard F, Teboul JL. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation[J]. Crit Care, 2000, 4(5):282-289.
9. Cannesson M, Musard H, Desebbe O, et al. The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients[J]. Anesth Analg, 2009, 108(2):513-517.
10. Pinsky MR, Payen D. Functional hemodynamic monitoring[J]. Crit Care, 2005, 9(6):566-572.
11. Marx G, Cope T, Mccrossan L, et al. Assessing fluid responsiveness by stroke volume variation in mechanically ventilated patients with severe sepsis[J]. Eur J Anaesthesiol, 2004, 21(2):132-138.
12. Reuter DA, Kirchner A, Felbinger TW, et al. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function[J]. Crit Care Med, 2003, 31(5):1399-1404.
13. Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients:a systematic review of the literature[J]. Crit Care Med, 2009, 37(9):2642-2647.
14. Monnet X, Rienzo M, Osman D, et al. Esophageal doppler monitoring predicts fluid responsiveness in critically ill ventilated patients[J]. Intensive Care Med, 2005, 31(9):1195-1201.
15. Feissel M, Michard F, Mangin I, et al. Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock[J]. Chest, 2001, 119(3):867-873.
16. Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery[J]. Anesth Analg, 2001, 92(4):984-989.
17. Sandroni C, Cavallaro F, Marano C, et al. Accuracy of plethysmographic indices as predictors of fluid responsiveness in mechanically ventilated adults:a systematic review and metaanalysis[J]. Intensive Care Med, 2012, 38(9):1429-1437.
18. Feissel M, Michard F, Faller JP, et al. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy[J]. Intensive Care Med, 2004, 30(9):1834-1837.
19. 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.
20. Teboul JL, Monnet X. Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity[J]. Curr Opin Crit Care, 2008, 14(3):334-339.
21. Heenen S, De Backer D, Vincent JL. How can the response to volume expansion in patients with spontaneous respiratory movements be predicted?[J]. Crit Care, 2006, 10(4):R102.
22. 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.
23. Soubrier S, Saulnier F, Hubert H, et al. Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients?[J]. Intensive Care Med, 2007, 33(7):1117-1124.
24. De Backer D, Heenen S, Piagnerelli M, et al. Pulse pressure variations to predict fluid responsiveness:influence of tidal volume[J]. Intensive Care Med, 2005, 31(4):517-523.
25. Muller L, Louart G, Bousquet PJ, et al. The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness[J]. Intensive Care Med, 2010, 36(3):496-503.
26. De Backer D, Taccone FS, Holsten R, et al. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients[J]. Anesthesiology, 2009, 110(5):1092-1097.
27. Tavemier B, Robin E. Assessment of fluid responsiveness during increased intra-abdominal pressure:keep the indices, but change the thresholds[J]. Crit Care, 2011, 15(2):134.
28. De Waal EE, Rex S, Kruitwagen CL, et al. Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions[J]. Crit Care Med, 2009, 37(2):510-515.
29. Monnet X, Osman D, Ridel C, et al. Predicting volume responsiveness by using the end-expiratory occlusion in mechanically ventilated intensive care unit patients[J]. Crit Care Med, 2009, 37(3):951-956.
30. Monnet X, Bleibtreu A, Ferré A, et al. Passive leg-raising and endexpiratory occlusion tests perform better than pulse pressure variation in patients with low respiratory system compliance[J]. Crit Care Med, 2012, 40(1):152-157.
31. Vincent JL, Weil MH. Fluid challenge revisited[J]. Crit Care Med, 2006, 34(5):1333-1337.
32. Muller L, Toumi M, Bousquet PJ, et al. An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness:the mini-fluid challenge study[J]. Anesthesiology, 2011, 115(3):541-547.
33. Monnet X, Teboul JL. Passive leg raising[J]. Intensive Care Med, 2008, 34(4):659-663.
34. 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.
35. Biais M, Vidil L, Sarrabay P, et al. Changes in stroke volume induced by passive leg raising in spontaneously breathing patients:comparison between echocardiograph and Vigileo/FIoTrac device[J]. Crit Care, 2009, 13(6):R195.
36. Delerme S, Renault R, Le Manach Y, et al. Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers[J]. Am J Emerg Med, 2007, 25(6):637-642.

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