下腔静脉内径变异度判断房颤患者容量反应性的意义  

Does Inferior Vena Cava variability predict fluid responsiveness in critically ill patients with atrial fibrillation

作　　者：张宏民[1] 刘大为[1] 王小亭[1] 张青[1] 汤铂[1] 丁欣[1] 陈焕[1] 武钧[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院重症医学科,100730 [2]上海交通大学附属瑞金医院重症医学科

出　　处：《中华医学杂志》2015年第19期1453-1456,共4页National Medical Journal of China

摘　　要：目的 判断下腔静脉内径变异度能否作为判断合并房颤的重症患者容量反应性的指标.方法 选取自2014年1至12月北京协和医院重症医学科收治的房颤患者共34例,被动抬腿试验（PLR）前应用超声测量吸气末下腔静脉直径（Dinsp）和呼气末下腔静脉直径（Dexp）,下腔静脉内径变异度（VIVC）=（Dinsp-Dexp）/Dexp,记录患者PLR前后的血流动力学数据,应用超声测量左室流出道速度-时间积分（VTI）在PLR前后的变化.PLR后VTI上升＞15％作为有容量反应性的标准.绘制受试者工作曲线（ROC）确定VIVC判断房颤患者容量反应性的敏感度和特异度.结果 共34例患者中,有反应组14例,无反应组20例.有反应性组VIVC明显高于无反应组（P＜0.01）.以VIVC≥18％评价呼吸机控制通气重症房颤患者容量反应性,灵敏度为57.1％,特异度89.9％.结论 对于合并房颤的重症患者,下腔静脉内径变异度能作为判断容量反应性的指标.Objective To assess the reliability of the variability of the inferior vena cava diameter as an indicator of fluid responsiveness in critically ill patients with atrial fibrillation.Methods Adult critically ill patients with atrial fibrillation requiring mechanical ventilation were enrolled.The variability of the inferior vena cava diameter（VIVC） was measured during a breath and then calculated as the maximum diameter （Dmax） minus minimum diameter （Dmin） divided by Dmin.All the hemodynamic parameters were collected at baseline and after a manoeuvre of passive leg raising（PLR）.A 15% of VTI increase after the PLR was the criterion to identify the patients with or without fluid responsiveness.ROC curve was used to assess the sensitivity and specificity of VIVC as an indicator of fluid responsiveness for critically ill patients with atrial fibrillation.Results There were 34 patients enrolled in our study,with 14 of them responsed to PLR and the rest 20 did not.For patients with fluid responsiveness VIVC was significantly higher than patients without fluid responsiveness.The sensitivity and specificity of VIVC ≥ 16% to predict fluid responsiveness in patients with atrial fibrillation were 57.1% and 89.9% respectively.Conclusion VIVC proved to be a reliable predictor of fluid responsiveness in critical ill patients with atrial fibrillation.

关 键 词：心房颤动 血管容量 反应时间 腔静脉 下 变异 

分 类 号：R541.75[医药卫生—心血管疾病] R459.7[医药卫生—内科学]