超声测定下腔静脉管径在围术期容量评估及治疗中的应用

Application of ultrasonic measurement of diameter of inferior vena cava in perioperative volume assessment and treatment

目的探讨超声测定下腔静脉(IVC)管径在围术期容量评估及治疗中的应用价值。方法超声测定46例术后常规镇静中出现低血压的高龄患者IVC吸气末最小管径及呼气末最大管径,计算IVC呼吸变异率(RIVC),同时测量CVP。输注200、500、1000ml复方氯化钠液体后分别再次测量IVC管径及CVP。结果与治疗前相比,容量治疗后CVP增加,IVC管径增宽,RIVC降低(P<0.01)。IVC管径和RIVC均与CVP密切相关(P<0.01)。取IVCmax1.59cm为临界值时,其预测CVP 8mm Hg的敏感度90.5%,特异度70.4%;IVCmin1.12cm时,预测CVP 8mm Hg的敏感度97.6%,特异度79.6%;RIVC为30.5%时,预测CVP 8mm Hg的敏感度77.5%,特异度90.5%。结论在高龄患者容量评估及治疗中,应用超声测定IVC管径和计算RIVC在一定程度上可预测CVP水平。

Objective To explore the application value of ultrasonic measurement of the diameter of inferior vena cava（IVC）in perioperative volume assessment and treatment of elderly.Methods The IVC diameter of 46 aged patients undergoing leg operation and with hypovolemia both during expiration and inspiration were measured with ultrasonography before and after fluid resuscitation of 200,500 and 1000ml.Central venous pressure（CVP）was recorded as well.Results Compared with before,CVP and IVC diameter were significantly increased and the respiratory variation of IVC（RIVC）was significantly decreased after fluid resuscitation（P〈0.01）.The IVC diameter and RIVC were closely correlated to CVP（P〈0.01）,which were regarded as the optimal parameters to predict CVP at 8mm Hg.Taking IVCmax1.59 cm as a cutoff value,the sensitivity and specificity for predicting CVP at 8mm Hg were 90.5% and 70.4%,respectively,taking IVCmin1.12 cm,the sensitivity and specificity for predicting CVP at 8mm Hg were 97.6% and 79.6%,and taking RIVC 30.5%,the sensitivity and specificity for predicting CVP at 8mm Hg were 77.5% and 90.5%.Conclusion During perioperative volume assessment and treatment of elderly patients,the ultrasonic measurement of IVC diameter and calculation of RIVC have a certain value in predicting CVP.