不同呼吸状态下颈内静脉及锁骨下静脉塌陷指数对低血容量的评估价值  

Alternative value of volume evaluation of internal jugular vein and subclavian vein collapse index in different respiratory states

作　　者：陈代宇 高吴茜 王思琦 李佼妮 曹俊[1] Chen Dai-Yu;Gao Wu-Xi;Wang Si-Qi;Li Jiao-Ni;Cao Jun(Department of Anesthesiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院麻醉科,重庆400016

出　　处：《解放军医学杂志》2023年第1期64-70,共7页Medical Journal of Chinese People's Liberation Army

基　　金：国家临床重点专科建设项目[(2011)170];重庆市医学重点学科项目[(2007)2]。

摘　　要：目的探讨自主呼吸及机械通气状态下颈内静脉塌陷指数(IJVCI)、锁骨下静脉塌陷指数(SCVCI)替代下腔静脉塌陷指数(IVCCI)评估低血容量的临床价值。方法纳入2020年12月-2021年8月于重庆医科大学附属第一医院麻醉科行择期手术的100例患者。依据IVCCI的截断值,将患者分为低血容量组与非低血容量组,比较机械通气与自主呼吸状态下患者的各项循环指标。采用Pearson相关分析及Bland-Altman图分析IJVCI、SCVCI与IVCCI的相关性和一致性。采用ROC曲线分析IJVCI、SCVCI评估低血容量的效能。结果机械通气状态下患者的SpO_(2)较自主呼吸状态下明显增高,心率、收缩压(SBP)、舒张压(DBP)、IVCCI、IJVCI、SCVCI明显降低(P<0.01)。自主呼吸状态下,非低血容量组IJVCI、SCVCI较低血容量组明显降低(P<0.001);机械通气状态下,非低血容量组SBP较低血容量组明显升高(P<0.05),IJVCI、SCVCI较低血容量组明显降低(P<0.001)。自主呼吸和机械通气状态下,IJVCI与IVCCI均呈明显正相关关系(r=0.586,P<0.01;r=0.514,P<0.001),且一致性较好;SCVCI与IVCCI均呈正相关关系(r=0.385,P<0.01;r=0.521,P<0.01),且一致性较好。自主呼吸状态下,IJVCI、SCVCI评估低血容量的ROC曲线下面积(AUC)分别为0.828、0.684,最佳截断值分别为22.2%、25.4%;机械通气状态下,IJVCI、SCVCI评估低血容量的AUC分别为0.701、0.773,最佳截断值分别为19.8%、13.2%。结论IJVCI与SCVCI在不同呼吸状态下均可替代IVCCI进行低血容量评估,但自主呼吸状态下IJVCI评估低血容量的价值更高,机械通气状态下SCVCI评估低血容量的价值更高。Objective To explore the alternative value of internal jugular vein collapsibility index(IJVCI)and subclavian vein collapsibility index(SCVCI)used to substitute for inferior vena cava collapsibility index(IVCCI)in volume evaluation under spontaneous breathing and mechanical ventilation.Methods A total of 100 patients were selected who underwent elective surgery in the Department of Anesthesiology,the First Affiliated Hospital of Chongqing Medical University from December 2020 to August 2021,the cyclic indicators of patients with different respiratory states were compared.According to the cut-off value of IVCCI,the patients were divided into hypovolemic group and non-hypovolemic group,and the cyclic indicators of the two groups were compared under different respiratory states.Pearson correlation analysis and Bland-Altman analysis were used to determine the relevance and consistency between IJVCI,SCVCI and IVCCI.ROC curve was used to analyze the efficiency of IJVCI and SCVCI in volume evaluation.Results Under mechanical ventilation condition,compared to spontaneous breathing condition,the SpO_(2)of patients was obviously increased,and heart rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),IVCCI,IJVCI and SCVCI were significantly decreased(P<0.01).IJVCI and SCVCI in non-hypovolemic group were significantly lower than those in hypovolemic group under the condition of spontaneous respiration(P<0.001).Under the condition of mechanical ventilation,SBP in non-hypovolemic group was significantly increased than that in hypovolemic group(P<0.05),while IJVCI and SCVCI were significantly lower than those in hypovolemic group(P<0.001).Under the condition of spontaneous breathing and mechanical ventilation,there was a significant positive correlation and consistency between IJVCI and IVCCI(r=0.586,P<0.01;r=0.514,P<0.001),and that a significant positive correlation and consistency between SCVCI and IVCCI(r=0.385,P<0.01;r=0.521,P<0.01).The area under the ROC curve(AUC)of IJVCI and SCVCI for the diagnosis of hypovol

关 键 词：外周静脉 塌陷指数 超声 容量评估 

分 类 号：R614[医药卫生—麻醉学]