心脏超声联合下腔静脉变异度对感染性休克容量反应性的评估价值  

Value of cardiac ultrasound combined with respiratory variability index of interior vena cava in assessment of volume responsiveness of septic shock patients

作　　者：余群锋 叶晨曦 俞啸 王勇刚[2] YU Qun-feng;YE Chen-xi;YU Xiao;WANG Yong-gang(Longyou Branch,Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou,Zhejiang 324400,China;不详)

机构地区：[1]浙江大学医学院附属邵逸夫医院龙游分院,浙江衢州324400 [2]浙江大学医学院附属邵逸夫医院重症医学科,浙江杭州310016

出　　处：《中华医院感染学杂志》2024年第14期2163-2167,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医院卫生科技基金资助项目(2021KY757)。

摘　　要：目的 探讨心脏超声联合下腔静脉变异度(IVC-RV)对感染性休克容量反应性的评估价值.方法 纳入2020年10月-2023年10月在浙江大学医学院附属邵逸夫医院龙游分院收治的102例感染性休克患者为研究对象,根据容量负荷试验分为容量有反应组、容量无反应组.比较两组一般资料、扩容前后IVC-RVI、心输出量(CO)、主动脉时间速度积分(VTI)、心脏指数(CI)水平差异,分析感染性休克患者容量反应性的影响因素,受试者工作特征(ROC)曲线分析上述指标检测对容量有反应性评估价值.结果 容量有反应组与容量无反应组分别54例(52.94%)、48例(47.06%).容量有反应组末端B型钠尿肽前体(NT-proBNP)水平低于容量无反应组(P<0.05).扩容前容量有反应组IVC-RVI水平高于容量无反应组(P<0.05),CO、VTI水平低于容量无反应组(P<0.05),扩容后容量有反应组CI高于容量无反应组(P<0.05).扩容前IVC-RVI为影响感染性休克患者容量反应性的危险因素,CO和VTI、CI水平为其保护因素(P<0.05).ROC显示IVC-RVI、CO、VTI、CI及联合检测评估感染性休克患者容量有反应性的曲线下面积(AUC)均>0.60,且以联合最佳(P<0.05).结论 感染性休克患者中容量无反应患者占比较高,临床可通过超声联合下腔静脉变异度检测评估容量反应性.OBJECTIVE To explore the value of cardiac ultrasound combined with respiratory variability index of in-terior vena cava(IVC-RV)in assessment of volume responsiveness of the patients with septic shock.METHODS A total of 102 patients with septic shock who were treated in Longyou Branch,Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from Oct 2020 to Oct 2023 were recruited as the research subjects and were divided into the volume responsiveness group and the no volume responsiveness group according to the result of volume load test.The baseline data was compared between the two groups.The IVC-RVI,cardiac output(CO),aortic time velocity integral(VTI)and cardiac index(CI)were observed and compared before and after volume expansion.The influencing factors for the volume responsiveness of the septic shock patients were ana-lyzed,and the values of the above indexes in assessment of volume responsiveness were analyzed by means of re-ceiver operating characteristic(ROC)curves.RESULTS There were 54(52.94%)cases in the volume responsive-ness group and 48(47.06%)cases in the no volume responsiveness group.The N-terminal pro-B-type natriuretic peptide(NT-proBNP)level of the volume responsiveness group was lower than that of the no volume responsive-ness group(P<0.05);the IVC-RVI level of the volume responsiveness group was higher than that of the no vol-ume responsiveness group before the volume expansion(P<0.05),while the levels of CO and VTI of the volume responsiveness group were lower than those of the no volume responsiveness group(P<0.05);the CI of the vol-ume responsiveness group was higher than that of the no volume responsiveness group after the volume expansion(P<0.05).The IVC-RVI was the risk factor for the volume responsiveness of the septic shock patients before the volume expansion,while the CO,VTI and CI were the protective factors(P<0.05).ROC curve analysis showed that the areas under curves(AUCs)of the single and joint detection of IVC-RVI,CO,VTI and CI were all more than 0.60,a

关 键 词：感染性休克 容量反应性 超声 下腔静脉变异度 主动脉时间速度积分 心脏指数 

分 类 号：R445.1[医药卫生—影像医学与核医学]