超声观测不同部位下腔静脉内径形变指数的研究初探  

A pilot study of measuring inferior vena cava internal diameter on transverse section plane in different sites by ultrasonography

作　　者：张青[1] 刘大为[1] 王小亭[1] 张宏民[1] 何怀武[1] 柴文昭[1] 晁彦公 中国重症超声研究组(CCUSG) 

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]清华大学第一附属医院ICU/急诊科

出　　处：《中华内科杂志》2015年第6期491-495,共5页Chinese Journal of Internal Medicine

基　　金：卫生公益性行业科研专项经费项目（201202011）

摘　　要：目的 采用超声观测不同部位的下腔静脉内径形变指数（SCI）,为后期探讨下腔静脉内径SCI与重症患者容量状态、容量反应性的关系奠定基础.方法 收集2014年12月-2015年1月入住北京协和医院重症医学科的患者,超声观测剑突下及右侧腹腋中线部位不同呼吸周期的下腔静脉内径形态,计算下腔静脉内径SCI,并进行相关性分析.结果 共入选107例患者,60例患者因不能同时获得剑突下和右侧腹腋中线2个部位观察、或图像质量欠佳未入选本研究,47例患者均同时获得剑突下和右侧腹腋中线下腔静脉横切面的观察,男性26例,女性21例,年龄（59.1±18.7）岁;完全机械通气者5例,自主呼吸者42例.不同部位、不同呼吸状态下腔静脉纵切面下腔静脉内径值比较差异有统计学意义（P＜0.05）.吸气末下腔静脉横切面下腔静脉内径SCI剑突下为1.87±0.72,右侧腹腋中线为1.85±0.59,差异无统计学意义（P＞0.05）.呼气末下腔静脉横切面下腔静脉内径SCI剑突下为1.69±0.47,右侧腹腋中线为1.74±0.50,差异无统计学意义（P＞0.05）.相关性分析：横切面吸气末下腔静脉长径值、短径值、下腔静脉内径SCI,剑突下与右侧腹腋中线有相关性（r =0.866,P=0.000;r =0.887,P=0.000;r=0.424,P=0.003）;横切面呼气末下腔静脉长径值、短径值、下腔静脉内径SCI,剑突下与右侧腹腋中线有相关性（r=0.802,P=0.000;r=0.887,P=0.000;r =0.883,P=0.000）.结论 剑突下和右侧腹腋中线横切面、不同呼吸周期下腔静脉的长径、短径及下腔静脉内径SCI有良好的一致性与相关性,两个部位的测量可以相互替代.objective To investigate the shape change index （SCI） of inferior vena cava （IVC）measured from subcostal area and right mid-axillary line through ultrasonography laying the foundation for future research about SCI and volume status.Methods A total of 107 patients were enrolled in the Critical Care Medicine Department of Peking Union Medical College Hospital from December,2014-January,2015.The maximal diameter（MXD） and the minimal diameter（MID） were measured transversely from subcostal area and right mid-axillary line.The SCI was calculated.Results Totally 47 patients （42 with spontaneous breathing and 5 on mechanical ventilation） achieved measurements on transversal plane from subcostal area and right mid-axillary line.（1） The internal diameter of IVC on longitudinal plane measured from subcostal area was statistically different from that measured from right mid-axillary line both at end inspiration （P =0.001） and at end expiration （P =0.027）.（2）No difference were found in the SCI measured from subcostal and right mid-axillary line both at end inspiration and at expiration.（3）The internal diameter of IVC and the SCI measured on transversal plane from subcostal area correlated well with that measured from mid-axillary line both at end inspiration（SCI：r =0.866,P =0.000）and at end expiration（SCI：r =0.887,P =0.000）.Conclusions Inferior vena cava internal diameters and the shape change index measured through ultrasonography on transversal planefrom subcostal area are correlated well with those from midaxillary line.Measurements from the two sites can be replacedby each other.

关 键 词：超声检查 腔静脉 下 横切面 形变指数 

分 类 号：R445.1[医药卫生—影像医学与核医学]