床旁超声测量下腔静脉在老年颅脑术后患者液体管理中的价值  

The Value of Bedside Ultrasound Measurement of the Inferior Vena Cava in Fluid Management in Elderly Patients after Craniotomy

作　　者：周建勇[1] 黄宇静[1] 林尚奋 李展鹏[1] 凌双[1] 慕容锐 麦玉婵 ZHOU Jianyong;HUANG Yujing;LIN Shangfen;LI Zhanpeng;LING Shuang;MURONG Rui;MAI Yuchan(The First People’s Hospital of Zhaoqing,Zhaoqing 526000,China;不详)

机构地区：[1]广东省肇庆市第一人民医院,广东肇庆526000

出　　处：《中国医学创新》2021年第10期134-137,共4页Medical Innovation of China

基　　金：肇庆市科技创新指导类项目(201904030751)。

摘　　要：目的:分析床旁超声测量下腔静脉在老年颅脑术后患者液体管理中的价值,从而指导液体复苏、优化治疗方案。方法:选取2019年5月-2020年12月本院颅脑术后存在低血容量的患者80例。按照随机数字表法将其分为中心静脉压组(CVP组)与超声组,各40例。超声组以测量下腔静脉直径(IVCD)及其呼吸变异指数(RVI)作为液体复苏标准;CVP组以传统的"2~5"法则为导向进行容量负荷试验为复苏标准。监测并比较两组血流动力学指标及并发症发生情况。结果:复苏前,两组患者MAP、Lac、LCR、HR以及尿量比较,差异均无统计学意义(P>0.05);复苏2、4、6 h,两组上述相关指标均有好转趋势。超声组复苏6 h的MAP、Lac、LCR、HR以及尿量与CVP组比较,差异均有统计学意义(P<0.05)。超声组血管活性药物应用时间、机械通气时间以及住ICU时间均短于CVP组,差异均有统计学意义(P<0.05)。超声组并发症发生率及存活率均优于CVP组,差异均有统计学意义(P<0.05)。结论:通过床旁超声测量下腔静脉在老年颅脑术后患者液体管理中的价值较高,可有效降低老年颅脑术后患者并发症发生率,并且改善颅脑术后患者的生存率,缩短患者ICU住院时间。Objective:To analyze the value of bedside ultrasound measurement of inferior vena cava(IVC)in fluid management in elderly patients after craniotomy,so as to guide fluid resuscitation and optimize treatment plan.Method:A total of 80 patients with hypovolemia after craniocerebral surgery in our hospital from May 2019 to December 2020 were selected.According to random number table,they were divided into central venous pressure group(CVP group)and ultrasound group,40 cases in each group.In the ultrasound group,the diameter of inferior vena cava(IVCD)and respiratory variation index(RVI)were measured as the standard of fluid resuscitation.In the CVP group,the traditional"2-5"rule was used as the guide to carry out the capacity load test.Hemodynamic indexes and complications were monitored and compared between the two groups.Result:Before resuscitation,there were no significant differences in MAP,Lac,LCR,HR and urine volume between two groups(P>0.05).After 2,4 and 6 h of recovery,the above related indicators in the two groups showed a trend of improvement.MAP,Lac,LCR,HR and urine volume of the ultrasound group were compared with those of the CVP group at 6 h of resuscitation,the differences were statistically significant(P<0.05).The application time of vasoactive drugs,mechanical ventilation time and ICU stay time in the ultrasound group were shorter than those in the CVP group,the differences were statistically significant(P<0.05).The incidence of complications and survival rate in the ultrasound group were better than those in the CVP group,the differences were statistically significant(P<0.05).Conclusion:Measurement of inferior vena cava by bedside ultrasound has a high value in fluid management of elderly patients after craniocerebral surgery,which can effectively reduce the incidence of complications in elderly patients after craniocerebral surgery,improve the survival rate of patients after craniocerebral surgery,and shorten the length of stay in ICU of patients.

关 键 词：床旁超声 下腔静脉 老年颅脑术 液体管理 

分 类 号：R651.1[医药卫生—外科学]