不同静脉内径呼吸变异度预测脓毒症休克合并心肌损伤患者容量反应性的准确性  

Accuracy of respiratory variation of different vein diameters in predicting fluid responsiveness in patients with septic shock complicated with myocardial injury

作　　者：龙玲[1] 赵浩天[2] 任珊[1] 申丽旻[1] Long Ling;Zhao Haotian;Ren Shan;Shen Limin(Intensive Care Unit,Hebei General Hospital,Shijiazhuang 050000,China;Department of Ultrasound,Hebei General Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省人民医院重症医学科,石家庄050000 [2]河北省人民医院超声科,石家庄050000

出　　处：《中华麻醉学杂志》2019年第9期1135-1138,共4页Chinese Journal of Anesthesiology

基　　金：河北省科技计划自筹经费项目(152777146)。

摘　　要：目的评价经剑突下下腔静脉内径变异度(v-IVCTX)、经肝下腔静脉内径变异度(v-IVCTL)、颈内静脉内径变异度(v-IJV)和股静脉变异度(v-FV)预测脓毒症合并心肌损伤患者容量反应性的准确性。方法选取ICU脓毒症休克合并心肌损伤患者50例,年龄≥18岁,使用PiCCO监测血流动力学,测定CO和SV,使用超声测量并计算v-IVCTX、v-IVCTL、v-IJV和v-FV。于满足液体治疗标准时进行补液试验,补液后CO增幅>10%定义为容量反应性阳性。将患者分为容量反应阳性组和容量反应阴性组。使用受试者工作特征(ROC)曲线评价各静脉内径呼吸变异度预测容量反应性的准确性。结果与容量反应阴性组比较,容量反应阳性组v-IVCTX、v-IVCTL和v-IJV升高(P<0.05),v-FV、CO和SV差异无统计学意义(P>0.05)。v-IVCTX、v-IVCTL、v-IJV预测容量反应性的诊断截断值分别为16.5%、14.5%和12%,灵敏度分别为80%、76%、84%;特异度分别为72%、64%、44%;ROC曲线下面积(95%可信区间)分别为0.777(0.642~0.911)、0.741(0.605~0.876)、0.694(0.549~0.838)。结论v-IVCTX和v-IVCTL均可预测脓毒症合并心肌损伤患者容量反应性.Objective To evaluate the accuracy of trans-xiphoid inferior vena cava diameter variation(v-IVCTX),trans-liver inferior vena cava diameter variation(v-IVCTL),internal jugular vein diameter variation(v-IJV)and femoral vein diameter variation(v-FV)in predicting the fluid responsiveness in the patients with septic shock complicated with myocardial injury.Methods Fifty patients with septic shock complicated with myocardial depression admitted to intensive care unit of our hospital,aged≥18 yr,were selected.The hemodynamics was monitored by PiCCO.Cardiac output(CO)and stroke volume were measured,and v-IVCTX,v-IVCTL,v-IJV and v-FV were measured by ultrasound and then calculated.Fluid replacement test was performed after meeting the standard of fluid resuscitation,and positive fluid responsiveness was defined as increase in CO after volume expansion>10%.Patients were divided into positive fluid responsiveness group and negative fluid responsiveness group.The receiver operating characteristic curve was drawn to evaluate the accuracy of the respiratory variation of each vein diameter in predicting fluid responsiveness.Results Compared with negative fluid responsiveness group,v-IVCTX,v-IVCTL and v-IJV were significantly increased(P<0.05),and no significant change was found in v-FV,CO or stroke volume in positive fluid responsiveness group(P>0.05).The cutoff value of v-IVCTX,v-IVCTL and v-IJV in predicting fluid responsiveness was 16.5%,14.5%and 12%,respectively,the sensitivity was 80%,76%and 84%,respectively,and the specificity was 72%,64%and 44%,respectively.The area under the curve(95%confidence interval)of v-IVCTX,v-IVCTL and v-IJV was 0.777(0.642-0.911),0.741(0.605-0.876),and 0.694(0.549-0.838),respectively.Conclusion v-IVCTX and v-IVCTL both can predict the fluid responsiveness in the patients with septic shock complicated with myocardial injury.

关 键 词：休克 脓毒症 血管容量 下腔静脉 颈静脉 股静脉 

分 类 号：R459.7[医药卫生—急诊医学] R542.2[医药卫生—治疗学]