超声测量下腔静脉横切面内径及面积快速评估老年患者术前血容量的价值分析

The value of ultrasound measuring the diameter and area of the transverse section of the inferior vena cava for rapid assessment of preoperative blood volume in elderly patients

目的探讨超声测量下腔静脉(inferior vena cava,IVC)横切面内径及面积以快速评估老年患者术前血容量的应用价值。方法选取2017年6月至2018年9月枣庄市峄城区人民医院35例胃肠手术的老年患者,按照中心静脉压(central venous pressure,CVP)<5 cmH2O(1 cmH2O=0.098 kPa)和≥5 cmH2O分为低血容量组(n=10)和对照组(n=25)。超声测量IVC横切面的长径(long diameter,LD)、短径(short diameter,SD)及其横切面面积以及IVC内径形变指数(shape change index,SCI),采用Pearson相关分析IVC各参数与CVP的相关性,并进行ROC分析。结果与对照组相比,低血容量组IVC的LD[(1.93±0.67)cm比(2.23±0.54)cm,P=0.01]、SD[(0.89±0.35)cm比(1.55±0.44)cm,P=0.01]和面积([1.61±0.67)cm^2比(2.23±0.85)cm^2,P=0.01]明显减低,SCI明显升高([2.43±0.57)比(1.43±0.32),P=0.01]。Pear⁃son相关分析显示,LD、SD、面积与CVP呈正相关(r=0346、0.754、0.534,P<0.05);ROC分析显示,SCI和SD的AUC分别为0.93、0.89(P<0.01)。结论超声测量IVC横切面的SD、LD、面积和SCI在一定程度上能够为老年患者术前血容量评估提供参考,且SD和SCI预测老年患者术前低血容量的效能更高。

Objective To evaluate the value of ultrasonography in measuring the diameter and area of inferior vena cava(IVC)transverse section for rapid assessment of preoperative blood volume in elderly patients.Methods From June 2017 to September 2018,35 elderly patients for gastrointestinal surgery were prospectively analyzed.They were divided into two groups according to central venous pressure(CVP),the low blood volume group(n=10)and the control group(n=25).Long diameter(LD),short diameter(SD)and area were measured by ultrasound,and the correlation between IVC parameters was analyzed by Pearson correlation.ROC was analyzed.Results LD,SD and area in the low blood volume group were significantly lower than those in the control group[LD:(1.93±0.67)cm vs.(2.23±0.54)cm,P=0.01;SD:(0.89±0.35)cm vs.(1.55±0.44)cm,P=0.01;area:(1.61±0.67)cm^2 vs.(2.23±0.85)cm^2,P=0.01],and SCI was higher than that in the control group[(2.43±0.57)vs.(1.43±0.32),P=0.01].Pearson correlation analysis showed that LD,SD,area were positively correlated with CVP(r=0346,0.754,0.534,P<0.05);ROC analysis showed that the AUC of SCI and SD were 0.93,0.89(P<0.05).Conclusions Ultrasound measurement of SD,LD and area on IVC cross section can provide reference for the preoperative blood volume assessment of the elderly patients,and SD and SCI can predict the preoperative blood volume of the elderly patients more effectively.