The Difference Between Iliac Venous Pressure And The Superior Vena Cava Pressure Changes On The Assessment Of Fluid Responsiveness On Abdominal Hypertension Patients

Objective:In this experiment, the mechanical ventilation patients with early septic shock in ICU, as the research object; study the different PEEP levels in the case of intra-abdominal pressure on the vena cava pressure (Vena, cava venous pressure, VCVP); and to assess the superior vena cava pressure (VCVP), iliac vein pressure (Central Iliac vein pressure, CIVP), iliac vein and superior vena cava pressure (Pcivp-vcvp), Global end The diastolic index (GEDI) to judge the capacity in patients with septic shock the significance of the reactivity.Methods:February2011and March2012, included stay at the ICU of Xiangya Hospital, in line with the21cases of septic shock in patients with septic shock diagnostic criteria and intra-abdominal pressure greater than18cmH2O application of the pulse indicates the continuous cardiac output monitoring system (PICCO) monitoring of hemodynamic parameters to be femoral vein catheter connected direct pressure measurement devices; rapid injection of a line capacity of500ml saline load test, before and after record expansion in patients with superior vena cava pressure (VCVP), iliac venous pressure (CIVP), difference between iliac vein and superior vena cava pressure (PCIVP-VCVP), dedicated end-diastolic volume index (GEDI), cardiac output (CO), and calculate the change in value before and after each parameter expansion are denoted superior vena cava pressure variability (△VCVP), iliac vein pressure the variability (△CIVP), dedicated end-diastolic volume index of variability (△GEDI), iliac vein and superior vena cava pressure difference variability (△PCIVP-VCVP); and calculate compliance, cardiac index (cardiac compliance, the CC)(CC=the△GEDI/△VCVP); capacity load test before and after changes in the value of the cardiac output (△CO) is greater than15%is divided into capacity of reactive groups and the capacity of the reactive group, the parameter differences between the two groups were compared.Results:21cases of septic shock patients,11male and10female, mean age41±32.4years, APACHE II score21±4.3; VCVP of patients, PEEP15cmH2O compared with PEEP was5cmH2O significant difference, P <0.05, significant difference compared with the PEEP10cmH20, P<0.05; capacity load test CIVP, PCIVP-VCVP, GEDI, CO,,the HR, MAP, etc. between the two groups were not statistically different (P>0.05).; after volume load test, has a capacity of the reactive group (△CO>15%)13 people, no capacity of the reactive group (△CO<15%); the superior vena cava pressure variability (△VCVP) in the two groups patients, no statistically significant difference (P>0.05); but has a capacity of reactive groups,△PCIVP-VCVPand△GEDI, the increase was significantly greater than the capacity of response group, the difference was statistically significant (P<0.05); Cardiac compliance in the capacity of response was significantly greater than the capacity of the no response group, the difference was statistically different (P<0.05).Conclusion:1、Intra-abdominal pressure in patients VCVP increased with positive end-expiratory pressure increased;2、Variability of the heart end-diastolic volume index of variability (△GEDI), variability of iliac vein and superior vena cava pressure (△PCIVP VCVP), can be used as indicators to determine fluid responsiveness,△PCIVP-VCVP sensitivity and highest specificity;3、Cardiac compliance is an important factor affecting the capacity of reactive.