摘要
目的分析健康成人吸气努力与下腔静脉(inferior vena cava,IVC)内径变异度的关系,探讨吸气努力对IVC内径变异度评估及液体反应性的影响。方法对2022年10月—2023年5月符合标准的健康受试者进行横断面研究,采用便携式肺功能仪测量受试者平静呼吸、中等力量吸气和深吸气3种状态下的吸气量,用于评估吸气努力程度。同时床旁超声测量IVC内径,计算IVC内径变异度。对吸气量和IVC内径变异度进行相关性分析,绘制受试者操作特征曲线,根据曲线下面积预测吸气努力诱发出现液体反应性的敏感性和特异性。结果共有95名受试者完成全部筛查,年龄(27.13±5.77)岁,其中男30名(32%)。平静呼吸时,41.1%的受试者IVC内径变异度≥50%;中等力量呼吸时,这一占比为68.4%;最大力量呼吸时,这一占比超过85%。吸气量与IVC内径变异度呈中度正相关,相关系数r=0.45。以IVC内径变异度≥50%为液体反应性阳性判断标准,吸气努力诱发出现液体反应性的曲线下面积为0.73(95%置信区间0.67~0.78,P<0.001),约登指数最大为0.41时,吸气量阈值为13 mL/kg理想体重,即中等力量呼吸便可诱发出现液体反应性,敏感性为79.57%,特异性为61.62%。结论吸气努力程度明显影响IVC内径变异度,自主呼吸情况下根据IVC内径变异度评价液体反应性可能会出现假阳性。
Objective To analyze the quantitative relationship between respiratory effort and inferior vena cava(IVC)diameter variability in healthy adults,and explore the effects of respiratory effort on the fluid responsiveness with IVC diameter variability.Methods From October 2022 to May 2023,a cross-sectional study was conducted in healthy young subjects who met the criteria.Respiratory effort was evaluated by using portable pulmonary function to measure the subjects’inspiratory conditions in three states(quiet breathing,moderate inspiration,and maximal inspiration).At the same time,the IVC internal diameter was measured by bedside ultrasound and the IVC diameter variability was calculated.The correlation between inspiratory volume and IVC diameter variation was analyzed,and the receiver operator characteristic(ROC)curve was drawn.The sensitivity and specificity of fluid responsiveness induced by inspiratory effort were predicted according to the area under the ROC curve(AUC).Results A total of 95 subjects were screened,aged 27.13±5.77 years,of whom 30(32%)subjects were males.During quiet breathing,41.1%of subjects had IVC inner diameter variation≥50%.For moderate inspiration,it was 68.4%.At maximum inspiration,this proportion is more than 85%.Inspiratory volume was moderately positively correlated with IVC diameter variation,and the correlation coefficient r=0.45.With the IVC diameter variation≥50%as the positive criterion for fluid responsiveness,the AUC of fluid responsiveness induced by inspiratory effort was 0.73(95%confidence interval 0.67-0.78,P<0.001),and the inspiratory volume threshold was 13 mL/kg ideal body weight when the maximum Youden index was 0.41.That is,moderate force breathing can induce fluid responsiveness,with sensitivity of 79.57%and specificity of 61.62%.Conclusion The degree of respiratory effort significantly affects the IVC inner diameter variation,and there may be false positives in the evaluation of fluid responsiveness according to IVC inner diameter variation in the case of spontan
作者
高攀
李宁
郭淑芬
牛净姿
崔朝勃
王金荣
GAO Pan;LI Ning;GUO Shufen;NIU Jingzi;CUI Zhaobo;WANG Jinrong(Department of Critical Care Medicine,Harrison International Peace Hospital Affiliated to Hebei Medical University,Hengshui,Hebei 053000,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
2024年第7期465-469,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
河北省“三三三人才工程”人才培养资助项目(C20221127)
衡水市科学技术局计划课题(2021014091Z)
关键词
下腔静脉内径变异度
吸气努力
液体反应性
Inferior vena cava diameter variability
respiratory effort
fluid responsiveness
