下腔静脉塌陷指数在低血容量性休克患者液体复苏疗效中的再评估

Reassessment of IVC-CI in fluid resuscitation for hypovolemic shock

目的 明确下腔静脉塌陷指数能否作为低血容量性休克患者液体复苏疗效评估指标,寻找超声检查指标用于反映指导早期低血容量性休克诊断治疗.方法 对急诊低血容量性休克患者进行500 mL生理盐水液体复苏治疗,在治疗前及治疗后分别记录一般生命体征同时测量床旁心脏超声参数,进行一般生命体征参数与超声参数的前后比较.结果 本研究共入组40例低血容量性休克患者,其中男性23例、女性17例,年龄为（50.00±17.71）岁,超声检查时间为（8.68±5.73） min,中心静脉导管置管时间为（29.32±8.06） min,下腔静脉塌陷指数IVC-CI治疗前和治疗后分别为（0.43±0.16）、（0.38±0.13）.左室流出道的峰流速Vpeak在液体复苏治疗前后的相关性为Vpeak补液前与补液后r值0.755、P为0.001.左室流出道峰流速Vpeak与左室舒张末容积LEDV在液体复苏治疗前后相关性P为0.03及0.05.结论 （1） IVC-CI并未表现出与液体复苏疗效间的相关性,本次实验认为不能作为其评估指标.（2）在本实验中,Vpeak在补液前后发生明显变化,整体为上升趋势.（3）Vpeak在本次实验中表现出与LEDV相关性,支持Vpeak是左室收缩功能指标的结论.（4）心脏超声检查耗时明显低于中心静脉导管置管时间.

Objective To study the utility of inferior vena cava-collapse index （IVC-CI） for assessing fluid resuscitation for hypovolemic shock in order to look for better echocardiographic markers to assess patients＆#39; condition with hypovolemic shock,also to look for optimal guidance for the adjustment of the treatment for these patients.Methods A total of 40 patients with hypovolemic shock admitted to Emergency Department were enrolled for study.All patients were treated with 500 mL normal saline iutravenously as fluid resuscitation.The vital signs and echocardiographic findings before and after the treatment were documented.Comparison of data between pre-treatment and post-treatment was carried out.Results Of 40 patients,there were 23 male and 17 female with average age （50.00 ± 17.71） years.The time consumed for echocardiography examination was （8.68 ± 5.73） min,time required for establishing central line was （29.32 ± 8.06） min.Collapse index of inferior vena cava （IVC-CI） before and after treatment were （0.43 ± 0.16） and （0.38 ± 0.13）,respectively.In hypovolemic shock group,the relationship of the peak velocity （Vpeak） of left ventricular outflow between before and after treatment was r =0.75,P =0.001.The relationship of the peak velocity of left ventricular outflow with left ventricular end diastolic volume （LEDV） before treatment was P =0.03 and after treatment was P =0.05.Conclusions （1） Between IVC-CI and the effectiveness of fluid resuscitation,there was no relationship.It was inappropriate to take IVC-CI as a marker for assessment.（2） Vpeak increased apparently after the fluid resuscitation.（3） Vpeak was proved to be associated with LEDV which supported that Vpeak is the indicator of left ventricular contractility.（4） Time consumed for echocardiography examination was shorter than that for establishing the central line in the group.