超声测量下腔静脉变异度对脓毒症患者容量反应性预测的Meta分析  

Meta-analysis on the Prediction of Volume Responsiveness of Patients with Sepsis by Ultrasonic Measurement of Variation in Inferior Vena Cava

作　　者：王曦[1] 刘忠足 WANG Xi;LIU Zhong-zu(The First Affiliated Hospital of Chongqing Medical University,Chongqing,400042 China)

机构地区：[1]重庆医科大学附属第一医院重症医学科,重庆400042

出　　处：《系统医学》2020年第3期46-50,共5页Systems Medicine

摘　　要：目的超声测量下腔静脉变异度(dIVC)对于脓毒症患者容量的反应性判断的可靠性评估。方法通过计算机检索PubMed、Medline、Cochrane Library、中国生物医学文献数据库(CBM)、万方数据库从建库至2019年6月关于下腔静脉变异度评估脓毒症患者容量状态的随机对照临床试验的相关文献。对纳入文献进行质量评价和资料提取,采用Review Manager 5.3软件、Stata 14.0软件进行Meta分析。结果该研究共纳入11篇前瞻性临床研究文献,其中包括有反应组331例,无反应组227例,两组间比较,差异有统计学意义[RR=3.84,95%CI(2.53,5.82),P<0.01],行诊断性试验准确性分析,总灵敏度0.71(95%CI:0.60~0.80),总特异度0.84(95%CI:0.77~0.89)。结论在脓毒症患者中仍有部分患者无容量反应性,超声测量下腔静脉变异度对于容量反应性预测效果好,有助于评估脓毒症患者容量状态管理以及改善预后。Objective To evaluate the reliability of diameter of inferior vena cava through ultrasound in predicting fluid responsiveness in patients with sepsis. Methods We searched in the PubMed,Medline, Cochrane Library, the Chinese Biomedical Literature Database(CBM), the Wanfang Database from the establishment until June 2019, those randomized controlled clinical trial to evaluate the fluid responsiveness of sepsis patients. To conduct the evaluation of quality of studies,and extraction of the literature, using the Review Manager 5.3 software and Stata14.0 to analyzing data. Results A total of 11 prospective clinical studies from 5 countries were included, including 331 cases in the reactive group and 227 cases in the non-reactive group.The variation of inferior vena cava in the reactive group was compared with the non-reactive group,the difference was statistically significant [RR=3.84,95%CI(2.53,5.82),P<0.01]. Further diagnostic accuracy analysis was performed, with a total sensitivity of 0.71(95%CI:0.60-0.80) and a total specificity of0.84(95%CI: 0.77-0.89). Conclusion There are still some patients without fluid responsiveness in sepsis. Ultrasound measurement of inferior vena cava variability has a good prediction on the fluid reactivity of sepsis patients, which may be helpful to assess the volume state and improve the prognosis.

关 键 词：下腔静脉变异度 呼吸变异指数 脓毒症 感染性休克 容量反应性 

分 类 号：R543.6[医药卫生—心血管疾病]