摘要
目的探讨颈内静脉(IJV)/颈总动脉(CCA)内径比值预估脓毒血症患者中心静脉压(CVP)的应用价值。方法脓毒血症患者112例分为A组(CVP<10 cmH2O,69例)和B组(CVP≥10 cmH2O,43例)。采用床旁超声测量右侧IJV和CCA内径,比较呼气末和吸气末的IJV和CCA内径,计算IJV/CCA内径比值,分析其与CVP的相关性。绘制ROC曲线分析IJV/CCA内径比值预估患者CVP≥10 cmH2O的诊断效能。结果 112例患者呼气末IJV内径和IJV/CCA内径比值均大于吸气末(P<0.01)。A组呼气末和吸气末的IJV内径和IJV/CCA内径比值均小于B组(P<0.01),且A组CVP低于B组(P<0.01)。呼气末IJV内径和CCA内径及IJV/CCA内径比值与CVP均呈正相关(r=0.565、0.234、0.686,P<0.05或P<0.01)。吸气末IJV内径、CCA内径及IJV/CCA内径比值与CVP也呈正相关(r=0.525、0.247、0.350,P<0.01)。呼气末和吸气末IJV/CCA内径比值预估CVP≥10 cmH2O的ROC曲线下面积分别为0.806[95%CI(0.726~0.887)]和0.751[95%CI(0.655~0.847)],取其最佳截断值分别为1.45和1.21时,其诊断CVP≥10 cmH2O的灵敏度分别为89.6%和81.4%,特异度分别为66.7%和60.9%。结论 IJV/CCA内径比值能较好地预估脓毒血症患者CVP;尤其当呼气末IJV/CCA内径比值大于1.45时,预估患者CVP≥10 cmH2O的灵敏度和特异度较高。
Objective To explore the value of the ratio of internal jugular vein(IJV) inner diameter to common carotid artery(CCA) inner diameter in predicting central venous pressure(CVP) in the patients with sepsis.Methods A total of 112 patients with sepsis was divided into two groups of A(CVP<10 cmH2O,69 cases) and B(CVP≥10 cmH2O,43 cases).The right IJV inner diameter and CCA inner diameter were measured by bedside ultrasound and the ratios of IJV inner diameter to CCA inner diameter at end-expiration and end-inspiration were calculated.The correlations of the ratios with CVP were analyzed.The ROC curve was drawn to analyze the diagnostic efficacy of the ratios in predicting the CVP≥10 cmH2O.Results Of 112 patients with sepsis,the IJV inner diameter and the ratio of IJV inner diameter to CCA inner diameter at end-expiration was more than those at end-inspiration(P<0.01).The IJV inner diameter and the ratios of IJV inner diameter to CCA inner diameter at end-expiration and end-inspiration in group A were less than those in group B(P<0.01).The CVP value of group A was lower than that of group B(P<0.01).The IJV inner diameter,CCA inner diameter and the ratio of IJV inner diameter to CCA inner diameter at end-expiration were positively correlated to CVP(r=0.565,0.234 and 0.686,P<0.05 or P<0.01) and so did at end-inspiration(r=0.525,0.247 and 0.350,P<0.01).The areas under the ROC curves of the ratios of IJV inner diameter to CCA inner diameter at end-expiration and end-inspiration in predicting the CVP≥10 cmH2O were 0.806 [95%CI(0.726-0.887)] and 0.751 [95%CI(0.655-0.847)].Taking the cut-off value of 1.45 for end-expiration and that of 1.21 for end-inspiration in predicting the CVP≥10 cmH2O,the sensitivities were of 89.6% and 81.4% and specificities were 66.7% and 60.9%,respectively.Conclusion The ratio of IJV inner diameter to CCA inner diameter can better predict the CVP value in the patients with sepsis.The higher sensitivity and specificity in predicting the patients with CVP ≥10 cmH2O are obtained when the cut-
作者
杨雪林
潘群婕
杨杰
兰频
潘锋
谢璐涛
陈美松
陈徐彬
YANG Xuelin;PAN Qunjie;YANG Jie(Department of Emergency,Lishui Municipal Central Hospital,Lishui 323000,CHINA)
出处
《江苏医药》
CAS
2020年第6期615-618,共4页
Jiangsu Medical Journal
基金
浙江省医药卫生科技计划项目(2020ZH013)。
关键词
颈内静脉
颈总动脉
中心静脉压
脓毒血症
Internal jugular vein
Common carotid artery
Central venous pressure
Sepsis
