下腔静脉直径及其变化率对低血容量患者的容量复苏意义

Significance of Diameter of the Inferior Vena Cava and Its Changing Rate on Volume Resuscitation of Patients with Hypovolemia

目的探讨低血容量患者容量复苏过程中动态监测下腔静脉直径及其变化率的临床意义。方法随机选取2014年1月—2016年12月该院收治的70例低血容量患者为研究对象,全部患者均行容量复苏,同期超声连续监测下腔静脉。记录不同补液量时患者的中心静脉压(CVP)及变化率(△1)和下腔静脉直径(IVCD)及变化率(△2)。观察CVP和IVCD、△1和△2间的相关性。结果补液量1 000 m L时,CVP(3.81±1.04)cm H2O、△1(0.83±0.30)%、ICVD(0.95±0.11)cm、△2(12.61±5.87)%,补液量3 000 m L时,CVP(7.92±1.81)cm H2O、△1(3.51±1.17)%、ICVD(2.02±0.16)cm、△2(39.58±5.93)%。经计算,CVP、IVCD与液体复苏量呈正相关(P<0.05),CVP与IVCD、CVP与△2、△1与△2均服从正态分布,线性回归分析结果显示存在相关性(P<0.05)。结论低血容量患者容量复苏过程中动态监测腔静脉直径及其变化率可间接评估患者的血容量情况,为容量复苏指标评定提供借鉴和参考。

Objective To study the clinical significance of dynamic monitoring of diameter of the inferior vena cava and its changing rate in the volume resuscitation course of patients with hypovolemia. Methods 70 cases of patients with hypovolemia admitted and treated in our hospital from January 2014 to December 2016 were selected as the research objects and all patients adopted the volume resuscitation, and the inferior vena cava was monitored by ultrasound at the same period,and the CVP and △1and IVCD and △2of patients at different fluid volumes, and the correlation between CVP and IVCD and △1and △2was observed. Results When the fluid volume was 1 000 mL, the CVP and △1and IVCD and △2were respectively（3.81±1.04）cm H2 O,（0.83 ±0.30）%,（0.95 ±0.11）cm and（12.61 ±5.87）%; when the fluid volume was 3 000 mL,the CVP and △1and IVCD and △2were respectively（7.92±1.81）cm H2 O,（3.51±1.17）%,（2.02±0.16）cm and（39.58 ±5.93）%, after calculation, the CVP and IVCD were positively correlated with the fluid resuscitation volume（P〈0.05）, and the CVP and △1and IVCD and △2were normal, and the liner regression analysis results showed that there was a correlation（P〈0.05）. Conclusion In the volume resuscitation course of patients with hypovolemia, the dynamic monitoring of diameter of the inferior vena cava and its changing rate can indirectly evaluate the blood volume of patients thus providing reference for the evaluation of volume resuscitation indexes.