下腔静脉直径和呼吸变异指数评估容量状态的Meta分析

Role of inferior vena cava diameter and respiration variation index in assessment of volume status:a meta-analysis

目的:评估超声测量下腔静脉直径和计算呼吸变异指数是否有助于评估急诊患者的容量状态。方法:通过计算机检索PubMed、EMbase、Medline、Cochrane Library、中国生物医学文献数据库(CBM)、万方数据库从建库至2013年1月关于下腔静脉直径和呼吸变异指数评估容量状态的随机对照临床试验的相关文献。对纳入文献进行质量评价和资料提取,并对符合质量标准的文献采用Review Manager 5.0软件(Cochrane图书馆协作)进行Meta分析。结果:本研究共纳入来源于5个国家的11篇随机对照试验文献,其中包括病例组214例、对照组328例。病例组下腔静脉最大直径与对照组比较,差异有统计学意义(Z=4.99,P<0.000 01);病例组下腔静脉直径呼吸变异指数与对照组比较,差异有统计学意义(Z=2.36,P=0.02)。结论:低血容量状态时,下腔静脉直径较对照组小,下腔静脉直径呼吸变异指数较对照组大;超声测量下腔静脉直径和计算呼吸变异指数有助于评估急诊患者的容量状态,其临床应用仍需要更多的大样本随机对照试验来进一步论证。

Objective：To conduct a meta-analysis to quantify existing evidence on sonographic measurement of inferior vena cava（IVC）diameter and respiration variation index in assessment of volume status with emergency department（ED）patients.Method：PubMed,Embase,Medline,Cochrane Library,Chinese Biomedical Literature Database（CBM）and WanFang Database were searched for Randomized controlled trials（RCTs）of IVC diameter and respiration variation index in assessing of volume status with ED patients from the date of establishment of the databases to January 2013.After quality assessment and data extraction,Mean difference in IVC diameter and respiration variation index were calculated by RevMan version 5.0（Cochrane collaboration）.Result：A total of 11 studies qualified for study eligibility from 5different countries,and studied 214 cases and 328 controls.Maximal IVC diameter and respiration variation index in cases group were significantly differently compared with controls group（Z=4.99,P〈0.000 01 and Z=2.36,P=0.02,respectively）.Conclusion：The analysis suggests that the IVC diameter is lower in hypovolemic status but respiration variation index is higher when they compared with euvolemic.Sonographic measurement of inferior vena cava（IVC）diameter and respiration variation index can help emergency physicians to assess of volume status with ED patients.Reliable conclusion still needs more large-sample,high-quality RCTs before it could be used in the ED.