床旁即时超声测量动脉峰流速呼吸变异度评价危重症患者容量反应性的临床价值  

Clinical value of point of care ultrasound measurements of variability of arterial peak flow velocity in evaluating volumetric reactivity in critically ill patients

作　　者：杨茂琼[1] 岳荣川[2] 罗艳芳[1] 张红英[1] YANG Mao-qiong;YUE Rong-chuan;LUO Yan-fang(Department of Out-patient,2 Department of Cardiovascular Medicine,Affiliated Hospital of North Sichuan Medical College,Nanchong Sichuan 637002,China)

机构地区：[1]川北医学院附属医院门诊部,四川南充637002 [2]川北医学院附属医院心血管内科,四川南充637002

出　　处：《临床和实验医学杂志》2024年第6期644-648,共5页Journal of Clinical and Experimental Medicine

基　　金：四川省中央引导地方科技发展专项项目(编号:2022ZYD0056)。

摘　　要：目的评估床旁即时超声(POCUS)测量动脉峰流速呼吸变异度(△Vpeak)评价危重症患者容量反应性的临床价值。方法回顾性选取川北医学院附属医院于2021年1月至2023年6月收治的100例危重症患者作为研究对象,所有患者均接受容量负荷(VE)试验,根据患者容量反应性分为有反应组[容量负荷后心脏每搏量(SV)增加≥15%,n=56]与无反应组(心脏指数增加<15%,n=44)。容量负荷前后均对患者实施床旁即时超声测量及中心静脉压(CVP)、脉压变异率(PPV)检测,比较两组容量负荷前后△Vpeak[主动脉血流峰流速(△Vpeak-AO)、颈总动脉血流峰流速(△Vpeak-CA)、肱动脉血流峰流速(△Vpeak-BA)、股动脉血流峰流速(△Vpeak-FA)]、CVP、PPV指标,并绘制受试者工作特征(ROC)曲线分析△Vpeak对危重症患者容量反应性的预测价值。结果容量负荷前,有反应组患者的△Vpeak-AO、△Vpeak-CA、△Vpeak-BA、△Vpeak-FA以及PPV分别为(15.42±4.24)%、(14.24±3.24)%、(13.29±2.54)%、(12.35±2.24)%、(13.32±2.53)%,均高于无反应组[(10.93±4.63)%、(10.48±3.16)%、(9.48±2.68)%、(7.84±2.16)%、(9.35±1.27)%],差异均有统计学意义(P<0.05),两组患者CVP比较差异无统计学意义(P>0.05);容量负荷后,有反应组与无反应组各项△Vpeak指标与PPV、CVP比较差异均无统计学意义(P>0.05)。△Vpeak-AO、△Vpeak-CA、△Vpeak-BA、△Vpeak-FA对危重症患者容量反应性敏感度、特异度及曲线下面积高于PPV。结论床旁即时超声测量△Vpeak能够有效预测危重症患者容量反应性,为临床诊断及治疗提供指导,具有较高临床价值。Objective To evaluate the clinical value of point of care ultrasound(POCUS)measurement of variability of arterial peak flow velocity(△Vpeak)in evaluating volume responsiveness in critically ill patients.Methods A retrospective study was conducted on 100 critically ill patients admitted to the Affiliated Hospital of North Sichuan Medical College from January 2021 to June 2023.All patients underwent volume load testing and were divided into a responsive group[with a cardiac stroke volume(SV)increase of≥15%after volume load,n=56]and an unresponsive group(with a cardiac index increase of<15%,n=44)based on their volume responsiveness.The POCUS,central venous pressure(CVP),and pulse pressure variability(PPV)were performed on patients before and after volume load.The△Vpeak[aortic variability of arterial peak flow velocity(△Vpeak-AO),carotid artery variability of arterial peak flow velocity(△Vpeak-CA),brachial artery variability of arterial peak flow velocity(△Vpeak-BA),femoral artery variability of arterial peak flow velocity(△Vpeak-FA)],CVP,and PPV indicators were compared between the two groups before and after volume load,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of△Vpeak on volume responsiveness in critically ill patients.Results Before volume load,the△Vpeak AO,△Vpeak CA,△Vpeak BA,△Vpeak FA,and PPV of patients in the responsive group were(15.42±4.24)%,(14.24±3.24)%,(13.29±2.54)%,(12.35±2.24)%,(13.32±2.53)%,respectively,which were higher than those in the non responsive group[(10.93±4.63)%,(10.48±3.16)%,(9.48±2.68)%,(7.84±2.16)%,(9.35±1.27)%],the differences were statistically significant(P<0.05).There was no statistically significant difference in CVP between the two groups of patients(P>0.05).After volume load,there were no statistically significant differences in various△Vpeak indicators,PPV,and CVP between the reactive and non reactive groups(P>0.05);△Vpeak AO,△Vpeak CA,△Vpeak BA,and△Vpeak FA have higher sensitivity,sp

关 键 词：中心静脉压 危重症 床旁即时超声 动脉峰流速呼吸变异度 容量反应性 

分 类 号：R459.7[医药卫生—急诊医学]