Application Value Of Different Doses Of Volume Loading Test In Assessment Of Volume Responsiveness In Elderly Patients With Septic Shock

Objective To guide the clinical rehydration treatment,improve the prognosis of patients and reduce the incidence of complications by exploring the application value of different doses of volume loading test in the evaluation of volume responsiveness in elderly patients with septic shock.Methods From July 1^st2018 to July 30^th2019,Sixty seven elderly patients were selected as the subjects of study who underwent septic shock and mechanical ventilation in intensive care department of Bozhou people’s Hospitalwere.The hemodynamic parameters were measured by transthoracic echocardiography before infusion.The corresponding parameters were evaluated after 80 ml of balanced solution was infused rapidly within 30 seconds,and the remaining 420 ml of balance solution was injected within 14.5 min to evaluate the corresponding parameters again.Hemodynamic parameters were recorded at baseline,30sec and 15min.Patients with increased cardiac output（CO）,i.e.,ΔCo≥15%,after rapid infusion of 80 ml of balanced solution within30 seconds,were included in the volume responsive group,otherwise,they were the nonresponsive group.The sensitivity and specificity of changes in aortic velocity time index（VTI）and CO（ΔCO）were calculated after 80 ml and 500 ml rehydration tests.In order to guide clinical treatment,the volume responsiveness in elderly patients with septic shock were predicted by evaluating the effect of volume loading test with different doses by receiver operating characteristic（ROC）curve.Results Before fluid resuscitation,there was no significant difference in gender,age,height,weight,acute physiology and chronic health scoreⅡ（APACHEⅡ）,sequential organ failure score（sofa）and dosage of vasoactive drugs between the two groups（P>0.05）;there was no significant difference in HR,map,CVP,PI and ultrasound related results（P>0.05）;there was no pulmonary edema in both groups and excess volume.The areas under ROC curve ofΔCO80 andΔvti80 were 0.961 and 0.929 respectively.WhenΔCO80≥15%,the sensitivity was 95.2%,the specificity was 87.5%,the Youden index was 0.827,the positive predictive value was 0.769,the negative predictive value was 0.976;whenΔvti80≥15%,the sensitivity was 85.7%,and the specificity was93.8%.Conclusion The volume responsiveness of elderly patients with septic shock can BE accurately predicted by applying the transthoracic echocardiography to monitor the variability of CO and VTI（ΔCO80 andΔvti80）caused by injection of 80 ml balanced solution within 30 seconds,and it can be used as an index to guide volume therapy.