摘要
目的探讨颈总动脉呼气末及吸气末流速对评估创伤合并休克患者容量反应性的意义。方法前瞻性研究2017年7月—2019年1月上海市浦东新区人民医院重症监护室收治需要机械通气控制呼吸的创伤合并休克患者60例,根据液体复苏后是否具有容量反应性(VR)且扩容前后心输出量(CO)变化是否≥15%将患者分为有反应(VR+组)及无反应(VR-组),各30例。VR+组男性23例,女性7例;年龄18~86岁,平均46.9岁。VR-组男性21例,女性9例;年龄18~90岁,平均46.1岁;采用迈瑞M9便携式多普勒超声取右颈总动脉长轴方向上测量两组患者呼气末最大血流速度(ex-Vmax)、吸气末最大血流速度(in-Vmax)与呼气末平均血流流速(ex-TAmax)、吸气末平均血流流速(in-TAmax),并计算出各自的变异度值:颈总动脉吸呼气末最大血流速度变异度(△Vmax)、吸呼气末平均血流速度变异度(△TAmax),分析不同组别上述数值的变化;绘制受试者工作特征(ROC)曲线,分析以上各项指标在容量反应性评估方面的价值。结果VR+组与VR-组in-Vmax[(71.72±18.67)cm/s vs.(79.47±24.04)cm/s]、in-TAmax[(40.67±11.44)cm/svs.(46.44±15.84)cm/s]比较无明显差异,但ex-Vmax[(61.00±17.84)cm/s vs.(76.86±25.28)cm/s]、ex-TAmax[(34.83±11.01)cm/s vs.(44.66±15.43)cm/s]比较差异有统计学意义(P<0.05)。VR+组与VR-组△Vmax(19.42%±14.18%vs.5.09%±13.59%)、△TAmax(18.19%±11.63%vs.4.29%±7.57%)比较差异有统计学意义(P<0.001)。ex-Vmax与ex-TAmax对创伤合并休克患者容量评估的ROC曲线下面积分别为0.695和0.678,而△Vmax与△TAmax的ROC曲线下面积均>0.800,分别是0.803和0.863,提示△Vmax、△TAmax对于创伤合并休克患者容量的评估更敏感。结论呼气末颈总动脉最大血流流速及平均血流流速、吸呼气末最大血流流速差异度及平均血流流速变异度均可用来评估机械通气创伤合并休克患者的容量反应性,且吸呼气末最大血流流速变异度及平均血流�
Objective To explore the significance of the end-expiratory and inspiratory flow velocities of the common carotid artery in evaluating the volume responsiveness(VR)in trauma patients with shock.Methods A prospective study was conducted from Jul.2017 to Jan.2019 in the ICU of Pudong New Area Peoples Hospital in Shanghai.Sixty trauma patients with shock requiring mechanical ventilation for respiratory control were enrolled.Based on whether they had VR after fluid resuscitation and whether the change in cardiac output(CO)before and after expansion was≥15%,the patients were divided into responsive(VR+group)and unresponsive(VR-group),with 30 patients in each group.There were 23 males and 7 females aged 18-86(mean 46.9)years in the VR+group,and 21 males and 9 females aged 18-90(mean 46.1)years in the VR-group.Mindray M9 portable Doppler ultrasound was used to measure the maximum expiratory blood flow velocity(ex-Vmax),maximum inspiratory blood flow velocity(in-Vmax),average expiratory blood flow velocity(ex-TAmax),and average inspiratory blood flow velocity(in-TAmax)in the long axis direction of the right common carotid artery in all patients.The variation values of the maximum inspiratory blood flow velocity(△Vmax)in the carotid artery and the variation of mean blood flow velocity at the end of inhalation and exhalation(△TAmax)were calculated.The receiver operating characteristic(ROC)curve was adopted to analyze the value of the abovementioned indicators in evaluating the VR.Results Comparison between the VR+group and the VR-group showed no significant difference in the in-Vmax(cm/s,71.72±18.67 vs.79.47±24.04)and the in-TAmax(cm/s,40.67±11.44 vs.46.44±15.84),but significantly lower ex-Vmax(cm/s,61.00±17.84 vs.76.86±25.28)and ex-TAmax(cm/s,34.83±11.01 vs.44.66±15.43)in the VR+group(both P<0.05).Moreover,△Vmax(%,19.42±14.18 vs.5.09±13.59)and△TAmax(%,18.19±11.63 vs.4.29±7.57)revealed more statistically significant differences between VR+and VR-groups(both P<0.001).The area under the ROC curve of ex-
作者
秦龙
万健
张黔
陈嵩
樊聪慧
郝怿隆
Qin Long;Wan Jian;Zhang Qian;Chen Song;Fan Conghui;Hao Yilong(Department of Emergency and Critical Medicine,Shanghai Pudong New Area Peoples Hospital,Shanghai201299,China)
出处
《创伤外科杂志》
2024年第1期56-60,共5页
Journal of Traumatic Surgery
基金
上海市浦东新区临床医学高原学科建设项目(PWYgy2021-09)
上海市浦东新区重点学科群建设项目(PWZxq2022-13)。
关键词
休克
床旁超声
颈总动脉血流流速
容量反应性
Shock
Bedside ultrasound
Common carotid artery blood flow velocity
Volume responsive-ness
