动脉血流峰值流速变异度评价危重症患者容量反应状态的Meta分析

Artery peak velocity variation for evaluation of fluid responsiveness in critical patients:a Meta analysis

目的应用Meta分析系统评价不同动脉血流峰值流速变异度(ΔVpeak)评估危重症患者容量反应状态的临床价值。方法检索PubMed、Embase、Medline、Cochrane Library、CBMdisc、万方数据库、中国知网及维普数据库,由两名检索员搜集关于床旁超声测量动脉ΔVpeak诊断危重症患者容量反应性的相关文献,依据纳入和排除标准对建库至2019年5月的相关文献进行筛选,对纳入文献进行质量评价和资料提取,质量评价标准为QUADAS条目,对符合质量标准的文献采用Stata 15.0软件进行分析,计算床旁超声测量动脉ΔVpeak诊断危重症患者容量反应性的合并敏感性、特异性、阳性似然比、阴性似然比、诊断比值比,绘制汇总受试者工作特征(SROC)曲线,计算曲线下面积;绘制漏斗图评估纳入文献是否存在发表偏倚。结果本研究共纳入15篇文献,肱动脉、颈动脉、主动脉及其联合的ΔVpeak诊断危重症患者容量反应性的合并敏感性分别为0.71(95%CI:0.63~0.78)、0.87(95%CI:0.77~0.93)、0.83(95%CI:0.74~0.91)、0.79(95%CI:0.74~0.83);合并特异性分别为0.85(95%CI:0.78~0.90)、0.85(95%CI:0.76~0.91)、0.84(95%CI:0.73~0.91)、0.85(95%CI:0.81~0.89);阳性似然比分别为4.7(95%CI:3.1~7.0)、5.8(95%CI:3.5~9.5)、5.1(95%CI:2.9~8.8)、5.3(95%CI:4.1~6.9);阴性似然比分别为0.34(95%CI:0.26~0.44)、0.16(95%CI:0.09~0.27)、0.21(95%CI:0.13~0.32)、0.25(95%CI:0.20~0.31);诊断比值比分别为13.63(7.57~24.54)、41.04(19.13~88.02)、21.99(10.49~46.11)、21.87(14.33~31.31);曲线下面积分别为0.86(95%CI:0.82~0.88)、0.92(95%CI:0.90~0.94)、0.89(95%CI:0.86~0.91)、0.89(95%CI:0.86~0.92)。漏斗图结果表明肱动脉、颈动脉、主动脉及其联合的纳入文献均无发表偏倚。结论ΔVpeak可用于评估危重症患者的容量反应性,其中颈动脉ΔVpeak诊断价值最高。

Objective To evaluate the clinical value of different artery peak velocity variation(△Vpeak) for predicting fluid responsiveness in critical patients by meta-analysis.Methods Databases of PubMed,Embase,Medline,Cochrane Library,CBMdisc,Wanfang,CNKI and VIP were retrieved.Two search members collected literatures corresponding to △Vpeak for evaluation of fluid responsiveness in critical patients by beside ultrasound.The related literatures from establishment to May 2019 were screened according to the inclusion and exclusion criteria referencing QUADAS entries,the quality of included literatures was evaluated and the original data included in the literatures were extracted.Stata 15.0 was used to analyze the related literatures,the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odd ratio of△Vpeak for evaluating fluid responsiveness in critical patients measured by beside ultrasound were calculated,summarized receiver operating characteristic(SROC) curve was drawn and area under curve(AUC) of SROC was calculated.Funnel plot was depicted to assess publication bias in enrolled studies.Results A total of 15 articles were included in the study.The pooled sensitivities were 0.71(95%CI:0.63-0.78),0.87(95%CI:0.77-0.93),0.83(95% CI:0.74-0.91) and 0.79(95% CI:0.74-0.83),the pooled specificities were 0.85(95%CI:0.78-0.90),0.85(95%CI:0.76-0.91),0.84(95%CI:0.73-0.91) and 0.85(95%CI:0.81-0.89),the pooled positive likelihood ratios were 4.7(95%CI:3.1-7.0),5.8(95%CI:3.5-9.5),5.1(95%CI:2.9-8.8) and5.3(95%CI:4.1-6.9),the pooled negative likelihood ratios were 0.34(95%CI:0.26-0.44),0.16(95%CI:0.09-0.27),0.21(95%CI:0.13-0.32) and 0.25(95%CI:0.20-0.31),the diagnostic odd ratios were 13.63(7.57-24.54),41.04(19.13~88.02),21.99(10.49~46.11) and 21.87(14.33~31.31),AUCs of SROC were 0.86(95% CI:0.82~0.88),0.92(95%CI:0.90~0.94),0.89(95%CI:0.86-0.91) and 0.89(95%CI:0.86-0.92) for ΔVpeak of brachial,carotid,aortic and their combination in diagnosing fluid responsiveness,respectively.The results of funnel plot demonstrated that there were no publication biases in studies of brachial,carotid,aortic and their combination.Conclusion ΔVpeak can be used to evaluate fluid responsiveness in critical patients,of which ΔVpeak of carotid artery has the highest diagnostic value.