超声测量下腔静脉内径的呼吸变异率评估高龄肺癌患者的容量负荷  

Evaluation of volume load in elderly patients with lung cancer by ultrasound measurement of respiratory variability of diameter of inferior vena cava

作　　者：扬慧娟 楼丽华 胡壮文 YANG Huijuan;LOU Lihua;HU Zhuangwen(Department of Anesthesiology,Zhejiang Jinhua Guangfu Tumor Hospital,Jinhua 321000,Zhejiang,China;Department of Anesthesia Operation,Zhejiang Jinhua Guangfu Tumor Hospital,Jinhua 321000,Zhejiang,China)

机构地区：[1]浙江金华广福肿瘤医院麻醉科,浙江金华321000 [2]浙江金华广福肿瘤医院麻醉手术部,浙江金华321000

出　　处：《中国现代医生》2023年第16期9-13,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2020PY085);金华市科技局计划项目(2022-4-214)。

摘　　要：目的探讨高龄肺癌患者超声测量下腔静脉内径的呼吸变异率(respiratory variability of diameter of inferior vena cava,RIVC)评估容量负荷的价值。方法选取2019年1月至2022年7月于浙江金华广福肿瘤医院择期行肺癌根治术的高龄患者78例为研究对象。术前30min超声检测RIVC和左室舒张末期容积(left ventricular end diastolic volume,LVEDV),根据术中平均动脉压(mean arterial pressure,MAP)和中心静脉压(central venous pressure,CVP)评估患者的容量负荷。结果78例患者中正常容量组39例、低容量组31例和高容量组8例。低容量组和高容量组患者的RIVC和LVEDV均显著高于正常容量组(P<0.05),但低容量组和高容量组患者的RIVC和LVEDV比较差异无统计学意义(P>0.05)。Spearman检验发现,RIVC与术中MAP和CVP均呈显著负相关(P<0.05),而LVEDV与术中MAP和CVP无显著相关性(P>0.05)。78例患者发生术中低血压9例,低血压患者的RIVC显著高于血压正常患者(P<0.05)。Logistic回归分析结果显示,RIVC与容量负荷异常(OR=5.023,95%CI:3.526~6.021,P<0.001)及低血压(OR=3.856,95%CI:2.754~4.859,P<0.001)紧密相关。受试者操作特征曲线显示,RIVC预测容量负荷异常与低血压的曲线下面积分别为0.859(95%CI:0.779~0.921,P<0.001)和0.807(95%CI:0.722~0.899,P<0.001)。结论超声术前检测RIVC对评估高龄肺癌患者容量负荷和低血压有较好的价值。Objective To explore value of respiratory variability of diameter of inferior vena cava(RIVC)by ultrasound for elderly patients with lung cancer to evaluate volume load.Methods A total of 78 elderly patients who received radical surgery for lung cancer in Zhejiang Jinhua Guangfu Tumor Hospital from January 2019 to July 2022 were selected as subjects.RIVC and left ventricular end diastolic volume(LVEDV)were measured by ultrasound 30 min before operation.According to mean arterial pressure(MAP)and central venous pressure(CVP)to assess patients’volume load.Results There were 39 patients in normal volume group,31 patients in low volume group and 8 patients in high volume group among 78 patients.The RIVC and LVEDV in high volume group and low volume group were significantly higher than normal volume group(P<0.05),but there was no significant difference in RIVC and LVEDV between low volume group and high volume group(P>0.05).Spearman test showed that RIVC was negative to MAP and CVP(P<0.05),but LVEDV was no correlation to MAP and CVP(P>0.05).There were 9 cases of hypotension in 78 patients.The RIVC in patients with hypotension was significantly higher than that in patients with normal blood pressure(P<0.05).Logistic regression analysis showed that RIVC was closely related to abnormal volume load(OR=5.023,95%CI:3.526-6.021,P<0.001)and hypotension(OR=3.856,95%CI:2.754-4.859,P<0.001).Receiver operating characteristic curve showed that RIVC predicted abnormal volume load and hypotension areas under the curve were 0.859(95%CI:0.779-0.921,P<0.001)and 0.807(95%CI:0.722-0.899,P<0.001),respectively.Conclusion Ultrasound for RIVC detection before operation has a good value in assessing volume load and hypotension in elderly patients with lung cancer.

关 键 词：超声 下腔静脉内径的呼吸变异率 高龄 肺癌 容量负荷 低血压 

分 类 号：R445.1[医药卫生—影像医学与核医学]