超声引导测量下腔静脉直径用于快速评估术前老年患者血容量的价值

Role of ultrasound guided measurement of inferior vena cava and right ventricular diameters in the assessment of volume status in elderly patients

目的探讨术前老年患者下腔静脉(IVC)及右心室(RV)直径的变化及其与中心静脉压(CVP)的关系,为快速无创判断术前老年患者的血容量提供参考依据。方法选择40例术前禁食的老年患者(实验组)与30例术前未禁食的老年患者(对照组)。实验组患者入手术室后记录心率(HR)、血氧饱和度(SpO2)、平均动脉压(MAP),超声下测量IVC的最大值和最小值、RV的最大直径,计算下腔静脉呼吸衰减指数(IVC-CI),局麻下行中心静脉穿刺测量CVP。输入6%羟乙基淀粉8 mL/kg后再次测量并记录HR、SpO2、MAP、IVC、RV的数值及CVP的变化。对照组在同一时间段记录HR、SpO2、MAP、IVC、RV的数值(CVP除外),不给予液体治疗。结果实验组呼气末的最大直径(IVCe)、吸气末的最小直径(IVCi)、RV均小于对照组(P<0.01)。实验组IVC-CI高于对照组(P<0.01)。液体治疗后IVC的最大直径升高46.5%,最小直径升高85.9%,并且与同期的CVP呈一定的正相关(r=0.598)。液体治疗后IVC-CI下降31.7%,与CVP呈负相关(r=-0.418)。结论术前禁食的老年患者的IVC、RV、CVP均处于较低的水平,超声引导下测量IVC及RV能够反映术前老年患者的血容量水平,可为血容量治疗提供参考依据。

Objective To evaluate inferior vena cava （IVC）and right ventricular （RV）diameters and their correla-tions with central venous pressure （CVP）for rapid evaluation of blood volume in elderly patients.Methods A total of 40 elderly patients with preoperative fasting （experimental group）and 30 healthy elderly volunteers （control group） were enrolled in the study.The heart rate （HR）,oxygen saturation （SpO2 ）,mean arterial pressure （MAP）of patients were recorded after they were sent to the operating room.The IVC diameters during expiration （IVCe）and inspiration （IVCi）,and the maximum RV diameter were measured with ultrasonography both before and after fluid resuscitation. The CVP was measured under local anesthesia.The HR,SpO2 ,MAP,IVC and RV of controls were measured during the time they participated in the study.Results The average diameters of the IVCe,IVCi,and RV in patients were significantly lower compared with healthy controls （P〈0.01）,while IVC-CI of patients was higher than that of con-trols.After fluid resuscitation,IVCe was increased by 46.5% and IVCi by 85.9%,which were positively correlated with synchronous CVP （r=0.598）;IVC-CI was reduced by 31.7%,which was negatively correlated with CVP （r=-0.418）.Conclusion The IVC and RV are consistently low in hypovolemic elderly patients when compared with healthy controls.Ultrasonographic measurements of IVC and RV diameters could be a useful noninvasive tool for the detection and follow-up of elderly patients with hypovolemia.