| 摘要: |
| 探讨超声监测下腔静脉变异度（ΔIVC）联合肺复张在机械通气急性循环衰竭患者容量反应性评估中的应用价值。方法 选取我院重症监护病房收治的急性循环衰竭且需机械通气的患者53例，依次完成肺复张和容量负荷试验，应用脉搏（请核对）指示剂连续心排血量监测仪分别于患者肺复张前、肺复张时测量平均动脉压（MAP）、中心静脉压（CVP）、每搏变异度（SVV）、全心舒张末容积指数（GEDI）、心脏指数（CI）和肺复张后CI变化率（ΔCILRM）等血流动力学指标，并根据容量负荷试验后CI变化率（ΔCIVE）将患者分为有反应组（ΔCIVE≥15％）28例和无反应组（ΔCIVE＜15％）25例。应用超声测量肺复张时下腔静脉直径及其变异度（ΔIVC）。比较两组上述参数的差异，分析（什么的？）上述血流动力学参数与ΔIVC的相关性。绘制受试者工作特征（ROC）曲线分析各血流动力学参数预测容量反应性的准确性。结果 肺复张前和肺复张时有反应组SVV高于无反应组，肺复张时有反应组和无反应组SVV均高于肺复张前，肺复张时有反应组下腔静脉直径差值（ΔDIVC）和ΔIVC均高于无反应组，差异均有统计学意义（均P＜0.05）。相关性分析结果显示，肺复张时MAP、SVV、ΔCILRM和ΔCIVE与ΔIVC均呈直线相关（r=-0.279、0.409、0.807、0.800，均P＜0.05），ΔCILRM与ΔCIVE呈直线相关（r=0.894，P＜0.05），而CVP和GEDI与ΔIVC均无相关性。ROC曲线分析显示，肺复张时SVV、ΔIVC和ΔDIVC评价容量反应性的曲线下面积分别为0.891、0.770、0.747，当SVV截断值为14.5%，其敏感性为60.7%，特异性为100%；当ΔIVC截断值为12.9%，其敏感性为78.6%，特异性为72%；当ΔDIVC截断值为0.25 cm，其敏感性为46.4%，特异性为88%。结论 超声监测ΔIVC联合肺复张可较准确地预测机械通气急性循环衰竭患者的容量反应性，具有重要的临床应用价值。 |
| 关键词: 下腔静脉变异度 容量反应性 急性循环衰竭 肺复张 超声心动图 |
| DOI： |
| 投稿时间：2021-10-15修订日期：2022-06-04 |
| 基金项目:无锡市卫生健康委科研面上项目(M202056) |
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| Application value of inferior vena cava variability combined with lung recruitment maneuver in volume responsiveness assessment in patients with acute circulation failure |
| ZHU Chao-yun,JIANG Bao-hu,LIU Yuan,WU Heng |
| () |
| Abstract: |
| Objective To investigate the application value of inferior vena cava variability（ΔIVC） combined with lung recruitment maneuver（LRM） in volume responsiveness assessment in patients with acute circulation failure.Methods Fifty-three patients with acute circulation failure undergoing mechanical ventilation admitted to intensive care unit of my hospital from January 2018 to December 2020 were enrolled.Lung recruitment maneuver and volume expansion（VE） were performed in sequence.The hemodynamic parameters including mean arterial pressure（MAP），central venous pressure（CVP），stroke volume variation（SVV），global end-diastolic volume index（GEDI），cardiac index（CI） and the variation ratio in cardiac index after lung recruitment maneuver(ΔCILRM) were monitored by pulse indicator continuous cardiac output before and during lung recruitment maneuver.The patients were divided into reaction group（ΔCIVE≥15％）28 cases and non-reaction group（ΔCIVE＜15％）25 cases according to the variation ratio in cardiac index after volume expansion（ΔCIVE）.Inferior vena cava diameter and ΔIVC were measured by ultrasonography during lung recruitment maneuver.The difference of the above hemodynamic parameters between the two groups were compared, and the correlations between the above hemodynamic parameters and ΔIVC were analyzed.Receiver operation characteristic (ROC) curve was drawn to predict the accuracy of all hemodynamic parameters for volume responsiveness.Results SVV before lung recruitment maneuver and during lung recruitment maneuver in reaction group was significantly higher than the of the non-reaction group（P＜0.05）.Both in reaction group and non-reaction group，SVV was significantly increased during lung recruitment maneuver as compared with that at before lung recruitment maneuver（P＜0.05）. ΔDIVC和ΔIVC in reaction group were significantly higher than those of the non-reaction group during lung recruitment maneuver（all P＜0.05）.MAP，SVV，ΔCILRM and ΔCIVE were linearity correlated with ΔIVC during lung recruitment maneuver.（r value was -0.279、0.409、0.807、0.800 respectively，all P ＜0.05），ΔCILRM was linearity correlated with ΔCIVE（r=0.894，P＜0.05），while no correlation was found between CVP and ΔIVC as well as GEDI and ΔIVC（r value was -0.106、0.107 respectively，all P >0.05）.The area under ROC curve of SVV，ΔIVC and ΔDIVC during lung recruitment maneuver for predicting fluid responsiveness was 0.891、0.770、0.747，respectively.When the cut-off value of SVV was 14.5%，the sensitivity was 60.7%，and the specificity was 100.0%.When the cut-off value of ΔIVC was 12.9%，the sensitivity was 78.6%，and the specificity was 72.0%.When the cut-off value of ΔDIVC was 0.25cm，the sensitivity was 46.4%，and the specificity was 88.0%.Conclusion Echocardiography assessment of ΔIVC combined with lung recruitment maneuver could accurately predict volume responsiveness in acute circulation failure patients with mechanical ventilation. |
| Key words: inferior vena cava variability volume responsiveness acute circulation failure lung recruitment maneuver echocardiography |
