超声技术评估禁饮禁食时长对患儿血容量的影响  

Influence of fasting duration on blood volume status of pediatric patients evaluated by ultrasonic technique

作　　者：王勤赛 周盈丰 王长红[1] 夏颖 李军[1] 袁开明[1] Wang Qinsai;Zhou Yingfeng;Wang Changhong;Xia Ying;Li Jun;Yuan Kaiming(Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital&Yuying Children's Hospital,Wenzhou Medical University,Wenzhou 325027,China;Department of Anesthesiology,Zhoushan Women and Children Hospital,Zhoushan 330902,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院麻醉与围术期医学科,温州325027 [2]舟山市妇幼保健院麻醉科,舟山330902

出　　处：《中华医学杂志》2020年第43期3425-3430,共6页National Medical Journal of China

基　　金：温州市科技局项目(Y2020755)。

摘　　要：目的:采用超声技术评估禁饮禁食时间与患儿诱导期血容量状态的关系。方法:选择2018年1至10月期间在温州医科大学附属第二医院实施择期手术患儿110例。七氟烷诱导镇静后,分别测量下腔静脉(IVC)直径最大值(呼气相,IVC max)、最小值(吸气相,IVC min)和心尖五腔心切面主动脉血流速度时间积分(VTI),并计算上述各个参数随呼吸变化的变异度;再行被动抬腿试验(PLR)重复测量和计算上述指标。对禁饮禁食时间长短与IVC变异度(IVC RVI)、主动脉VTI变异度(ΔVTI)行多元线性回归分析。结果:PLR前,IVC max、IVC min和IVC RVI分别为(0.78±0.19)、(0.43±0.15)cm和0.45±0.12;PLR后,IVC max和IVC min分别增加至(0.94±0.20)、(0.55±0.18)cm,而IVC RVI减小为0.42±0.13,差异均有统计学意义(t=15.66、10.85、3.14,均P<0.05)。IVC max、IVC min、IVC RVI均与禁饮禁食时长无相关性(PLR前:r=0.052、0.163、0.171;PLR后:r=0.062、0.169、0.165,均P>0.05)。PLR前,呼气相VTI(VTI max)、吸气相VTI(VTI min)和ΔVTI分别为21±5、17±4和17±8;PLR后,VTI max和VTI min分别增加至23±5、19±4,差异均有统计学意义(t=13.60、10.43,均P<0.05),而ΔVTI为17±8,差异无统计学意义(t=0.34,P>0.05)。回归分析发现主动脉VTI max、VTI min及ΔVTI均与禁饮禁食时长无相关性(PLR前:r=0.111、0.100、0.047;PLR后:r=0.003、0.033、0.073,均P>0.05)。多元线性回归(回退法)分析发现,无论PLR前后,年龄和体重均是IVC RVI和ΔVTI的影响因素(IVC RVI:β=-0.441、0.515、-0.451、0.507;ΔVTI:β=-0.442、0.545、-2.422、2.850;均P<0.05)。经年龄和体重校正后,禁饮禁食时长与IVC RVI以及ΔVTI仍无相关性(IVC RVI:β=0.177、0.160;ΔVTI:β=0.037、0.054;均P>0.05)。结论:患儿IVC直径和主动脉VTI随呼吸变异度与一定范围内的禁饮禁食时长无相关性,而与患儿的年龄和体重相关。Objective To evaluate the influence of preoperative fasting duration on blood volume status of pediatric patients during induction based on ultrasonic technique.Methods One hundred and ten pediatric patients,scheduled for elective operation in the Second Affiliated Hospital&Yuying Children's Hospital,were recruited during January and October in 2018.After sedation by inhalation of sevoflurane,the maximum(expiratory)and minimum(inspiratory)diameter of inferior vena cava(IVCmax,IVCmin)and aorta velocity-time integral(VTI)in apical five-chamber cardiac view were measured with an ultrasound machine.Respiratory variabilities of these parameters were further calculated.Furthermore,passive leg raising(PLR)test was performed and above measurements/calculations were repeated.The correlation between the duration of fasting and IVC respiratory variations index(IVCRVI)or aortic VTI variability(ΔVTI)was then analyzed.Results Before PLR,IVCmax,IVCmin and IVCRVI were(0.78±0.19),(0.43±0.15)cm and 0.45±0.12,respectively.After PLR,IVCmax and IVCmin increased to(0.94±0.20),(0.55±0.18)cm,while IVCRVI decreased to 0.42±0.13,the differences were statistically significant(t=15.66,10.85,3.14,all P<0.05).However,IVCmax,IVCmin and IVCRVI were not significantly correlated with the duration of fasting analyzed by linear regression(before PLR:r=0.052,0.163,0.171;after PLR,r=0.062,0.169,0.165,all P>0.05).Before PLR,expiratory aortic VTI(VTImax),inspiratory aortic VTI(VTImin)andΔVTI were 21±5,17±4 and 17±8,respectively.After PLR,the VTImax and VTImin significantly increased to 23±5 and 19±4(t=13.60,10.43,all P<0.05),butΔVTI was not changed significantly,which was 17±8(t=0.34,P>0.05).Linear regression analysis showed that VTImax,VTImin andΔVTI were not significantly correlated with the duration of fasting(before PLR:r=0.111,0.100,0.047;after PLR:r=0.003,0.033,0.073,all P>0.05).Further multiple linear regression analysis indicated that,age and body weight were independent factors influencing IVCRVI andΔVTI before and after PLR(I

关 键 词：儿童 禁食 下腔静脉 血流速度时间积分 超声检查 

分 类 号：R726.1[医药卫生—儿科] R445.1[医药卫生—临床医学]