摘要
目的:探讨经肝测量下腔静脉(IVC)直径在危重症患者容量反应性中的诊断价值。方法:回顾性分析2019年9月-2021年9月福建医科大学附属三明第一医院接受容量复苏的106例危重症患者的临床资料。患者均接受容量负荷试验,根据患者有无容量反应分为有容量反应组(50例)及无容量反应组(56例)。所有患者均进行血流动力学指标检查及经肝测量IVC直径。比较两组补液前后血流动力学指标及IVC参数,分析RVI对容量反应性的诊断价值。结果:补液后,有容量反应组中心静脉压(CVP)、呼气末最小直径(IVCmin)、吸气末最大直径(IVCmax)均较补液前有明显升高,呼吸变异指数(RVI)明显降低,无容量反应组CVP、IVCmin较补液前明显升高,RVI明显降低(P<0.05)。补液前,有容量反应组IVCmax、IVCmin低于无容量反应组,RVI高于无容量反应组(P<0.05)。RVI诊断危重症患者容量反应性的cut-off值、敏感度、特异度分别为18.06%、53.57%、94.00%,AUC为0.806(95%CI:0.725,0.886)。结论:经肝测量IVC直径参数在有容量反应及无容量反应患者中存在显著差异,RVI对危重症患者容量反应性的预测效能较好,可指导临床治疗。
Objective:To explore the diagnostic value of measurement of inferior vena cava(IVC)diameter via liver in volume responsiveness of critically ill patients.Method:The clinical data of 106 critically ill patients who received volume resuscitation from September 2019 to September 2021 in Sanming First Hospital Affiliated to Fujian Medical University were analyzed retrospectively.All patients received volume load test,and they were divided into volume response group(50 cases)and non volume response group(56 cases)according to whether the patients had volume response.All patients underwent hemodynamic indexes examination and measurement of IVC diameter via liver.The hemodynamic indexes,IVC parameters were compared between the two groups before and after fluid infusion,and the diagnostic value of RVI for volume responsiveness was analyzed.Result:After fluid infusion,the central venous pressure(CVP),minimum end expiratory diameter(IVCmin),and maximum end inspiratory diameter(IVCmax)in the volume response group were significantly higher than those before fluid infusion,and the respiratory variation index(RVI)reduced significantly,while CVP and IVCmin in the non volume response group were significantly higher than those before fluid infusion,RVI decreased significantly(P<0.05).Before fluid infusion,IVCmax and IVCmin in volume response group were lower than those in non volume response group,and RVI was higher than that in non volume response group(P<0.05).The cut-off value,sensitivity and specificity of RVI in diagnosing the volume responsiveness of critically ill patients were 18.06%,53.57%and 94.00%respectively,and the AUC was 0.806(95%CI:0.725,0.886).Conclusion:Measurement of IVC diameter via liver parameters have significant differences between patients with volume response and patients without volume response.RVI has a good predictive effect for volume responsiveness of critically ill patients,which can guide clinical treatment.
作者
官素虹
赖小冬
GUAN Suhong;LAI Xiaodong(不详;Sanming First Hospital Affiliated to Fujian Medical University,Sanming 365000,China)
出处
《中外医学研究》
2022年第33期72-75,共4页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
下腔静脉直径
容量状态
容量反应性
诊断价值
Inferior vena cava diameter
Capacity status
Volume responsiveness
Diagnostic value
