经胸壁床旁超声预测机械通气患者急性循环衰竭容量反应性的临床研究

doi:10.3969/j.issn.1002-1949.2017.12.014

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摘要目的: 探究颈内静脉呼吸塌陷指数(IJVR)、下腔静脉塌陷指数（IVCR）等指标在预测患者容量反应性中的价值。方法: 本研究为前瞻性临床研究，选取56例机械通气情况下诊断为急性循环衰竭(ACF)的患者。患者在输入500 mL胶体前后使用床旁超声测量颈内静脉呼吸周期中最大前后径IJVmax、最小前后径IJVmin，计算颈内静脉塌陷指数为（IJVmax－IJVmin）／IJVmax×100%，同时测量并计算出中心静脉压(CVP)及IVCR。通过分析相关指标的敏感度、特异度和受试者特征曲线（ROC）来评估IJVR、CVP及IVCR指标在预测容量反应性中的价值。结果: 56例患者中有容量反应性者32例占57%，无反应者24例占43%。扩容前后IJVR与ΔSV呈正相关性（r=0.809 , P＜0.05）；以IJVR ≥13%为阈值，其曲线下面积(AUC)为0.735(95%CI 0.603～0.866), 敏感度为 85.7%，特异度为70.3%；以 IVCR≥18.7 %为界值，AUC是0.853 (95%CI 0.696～0.956), 敏感度为86.7%，特异度为83%。IJVR联合IVCR预测容量反应性的AUC 0.895(95%CI 0.801～0.990)，敏感度为90.9%，特异度为89.3%。而当CVP ≤ 10 cm H2O时其AUC为0.653 (95%CI 0.441～0.828)，敏感度为56.7%，特异度为50.8%。结论: 应用超声测量是一个无创且简单的预测ACF 患者容量反应性的方法，当其联合IVCR时则能提高敏感度和特异度，更准确地进行容量反应性的预测。

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	王润泽
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	王春艳
	曹晓光

收稿日期: 2017-07-28

通讯作者: 周树生（1972-），男，硕士，主任医师，硕士生导师，E-mail:zhouss108@163.com

作者简介: 王润泽（1982-），男，硕士，住院医师，E-mail:stonedrow@163.com

引用本文:

王润泽，周树生，刘宝，查渝，黄羽，王春艳，曹晓光. 经胸壁床旁超声预测机械通气患者急性循环衰竭容量反应性的临床研究[J]. 中国急救医学, 2017, 37(12): 1134-1138.
ang Run-ze, Zhou Shu-sheng, Liu Bao, Zha Yu, Huang Yu, Wang Chun-yan, Cao Xiao-guang. A clinical investigation about using bedside ultrasound via chest wall to predict fluid responsiveness in acute circulatory failure patients with mechanical ventilation. Chinese Journal of Critical Care Medicine, 2017, 37(12): 1134-1138.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2017.12.014 或 http://www.cnemergency.org.cn/CN/Y2017/V37/I12/1134

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