下腔静脉变异度和中心静脉压对容量反应的敏感性比较

Comparison of Sensitivity of Inferior Vena Cava Variability and Central Venous Pressure to Volume Response

目的探讨下腔静脉变异度(d IVC)和中心静脉压(CVP)对容量反应的敏感性,从而为临床容量治疗提供理论依据。方法选取2016年5月—2018年3月间在该院进行手术治疗的患者80例,统计入室时(T1)、麻醉诱导5 min(T2)、补液治疗30 min(T3)、补液治疗1 h(T4)时心率(HR)、舒张压(DBP)、收缩压(SBP)、CVP、下腔静脉最小直径(IVCmix)及最大直径(IVCmax)变化情况,并分析d IVC和CVP对容量反应的敏感性、特异度。结果与T1时刻比较,T2时刻CVP降低,T2、T3时刻DBP、SBP降低,T3、T4时刻IVCmix及IVCmax升高(P<0.05);不同时间点HR比较,差异无统计学意义(P>0.05);d IVC及CVP对CI反应的AUC曲线分别为0.928、0.709,AUCdIVC高于AUCCVP(P<0.05);d IVC为12.5%时敏感性+特异度最大,此时敏感性为81.8%、特异度为94.4%;CVP为5.5 mmHg时敏感性+特异度最大,此时敏感性为72.7%、特异度为58.3%。结论 d IVC相比于CVP更有助于反映围术期患者容量反应情况,对容量反应诊断敏感性高、特异度高。

Objective To investigate the sensitivity of inferior vena cava variability(dIVC)and central venous pressure(CVP)to volume response,and to provide a theoretical basis for clinical volume therapy.Methods From May 2016 to March 2018 80 patients with surgical treatment were enrolled in our hospital.The time of entry(T1),anesthesia induction for 5 min(T2),fluid replacement for 30 min(T3),fluid replacement for 1 h(T4),heart rate(HR),diastolic Pressure(DBP),systolic blood pressure(SBP),CVP,minimum inferior vena cava diameter(IVCmix)and maximum diameter(IVCmax)were measured,and the sensitivity and specificity of dIVC and CVP for volume response were analyzed.Results Compared with T1,CVP decreased at T2,DBP and SBP decreased at T2 and T3,and IVCmix and IVCmax increased at T3 and T4(P<0.05).There was not statistically significant difference in HR at different time points(P>0.05).The AUC curves of dIVC and CVP for CI reaction were 0.928 and 0.709,respectively,and AUCdIVC was higher than AUCCVP(P<0.05).The sensitivity and specificity were the highest when dIVC was 12.5%.The sensitivity was 81.8%and the specificity was 94.4%;sensitivity and specificity were the highest when CVP was 5.5 mmHg,where the sensitivity was 72.7%and the specificity was 58.3%.Conclusion Compared with CVP,dIVC is more helpful in reflecting the volume response of patients in perioperative period.It has high sensitivity and high specificity for the diagnosis of volume response.