床旁超声测量颈内静脉横截面积评估中心静脉压的临床应用

Bedside ultrasound measurement of internal jugular vein cross-sectional area to assess central venous pressure

目的:探究颈内静脉横截面积(IJARs)与中心静脉压(CVP)之间的相关性,评估危重症患者的容量状态。方法:选取2019-09—2020-04期间入住我院急诊ICU,留置中心静脉导管,经床旁超声评估颈内静脉的患者,计算最大IJARs,分析其与CVP的相关性,利用ROC曲线评估IJARs预测CVP≥8 cmH2O的最佳截断值。结果:研究共纳入106例患者,其中58例(54.72%)CVP≥8 cmH2O,48例(45.28%)CVP<8 cmH2O。与CVP<8 cmH2O的患者相比,呼气末CVP≥8 cmH2O的患者IJARs较大,IJARs是预测CVP分组的独立预测因素(P<0.05)。以是否使用机械通气行分层分析,结果显示与非机械通气的患者相比,机械通气的患者IJARs较大,IJARs仍是预测CVP分组的独立预测因素。IJARs预测CVP≥8 cmH2O的ROC曲线下面积为0.677,截断值取0.79时预测效能最佳,敏感度为60.3%,特异度为70.8%。结论:床旁超声测量最大IJARs可以用来评估危重患者容量状态,但仍需要进一步的大样本数据来验证支持该结论。

Objective:To explore the correlation between internal jugular vein cross-sectional area(IJARs)and central venous pressure(CVP)to assess the volume status of critically ill patients.Method:From September 2019 to April 2020,patients who were admitted to the emergency ICU of our hospital,placed a central venous catheter,and evaluated the jugular vein by bedside ultrasound,calculated the maximum IJARs,and then analyzed their correlation with CVP,and evaluated them by ROC curve.IJARs predict the best cut-off value of CVP≥8 cmH2O.Result:A total of 106 patients were included in the study,of which 58(54.72%)had CVP≥8 cmH2O,and 48(45.28%)had CVP<8 cmH2O.Compared with patients with CVP<8 cmH2O,patients with end-expiratory CVP≥8 cmH2O had larger IJARs.IJARs were independent predictors of CVP grouping(P<0.05).Based on the stratified analysis of mechanical ventilation,the results show that compared with non-mechanical ventilation patients,mechanical ventilation patients have larger IJARs,and IJARs are still independent predictors of CVP grouping.The stratified analysis based on mechanical ventilation showed that the results were relatively stable.The area under the ROC curve predicted by IJARs for CVP≥8 cmH2O is 0.677,and the cutoff value is 0.79.The prediction efficiency is the best,the sensitivity is 60.3%,and the specificity is 70.8%.Conclusion:The maximum IJARs measured by bedside ultrasound can be used to assess the volume status of critically ill patients,and further large sample data are still needed to verify support.