床旁超声评估机械通气脓毒症患者血容量状态的临床研究

Clinical study of bedside ultrasound evaluation of blood volume status in sepsis patients with mechanical ventilation

目的为了解机械通气下应用床旁超声评估脓毒症患者血容量状态及容量反应性状况。方法随机选择2017年5月至2020年9月广西医科大学第一附属医院ICU 2区、广西中医药大学附属广西中西医结合医院ICU 2区及1区机械通气治疗脓毒症患者136例,应用脉搏指示剂连续心排血量监测(PICCO)、床旁超声同步检查,记录舒张末期容积指数、每搏变异率、下腔静脉最小直径(IVCD_(min))、IVC扩张指数,同时收取NT-pro BNP结果,进行统计分析。结果机械通气下患者各组舒张末期容积指数(GEDVI)对应IVCD_(min)差异有统计学意义(P<0.05),正常值GEDVI组IVCD_(min)x±s:(1.57±0.32)cm;IVCD_(min)反应机体容量不足的最佳截点为1.35 cm,敏感性及特异性分别为86.40%、84.80%;IVCD_(min)反应机体容量过负荷的最佳截点为1.81 cm,敏感性及特异性分别为76.50%、89.60%。下腔静脉扩张指数反映容量反应性最佳截点为14.47%,敏感性及特异性分别为87.7%、81.0%。结论对于机械通气下脓毒症患者,IVCD_(min)<1.35 cm,需注意机体血容量不足状态;IVCD_(min)>1.81 cm,应早期警惕容量负荷过重。临床应及时评估机体血容量状态及容量反应性,以准确指导液体管理。

Objective To understand the blood volume status and volume reactivity of patients with sepsis using bedside ultrasound under mechanical ventilation.Methods 136 cases of sepsis patients with breathing machine treatment were chosen at random from May 2017 to Sep 2020 in ICU 2 of the first Affiliated Hospital of Guangxi Medical University,and ICU 2 and 1 of Guangxi integrated traditional Chinese and western medicine hospital affiliated to Guangxi university of traditional Chinese medicine.The indicators of bedside ultrasound were recorded as the indicators of PICCO were obtained synchronously in ICUs,respectively.The indicators were end⁃diastolic volume index,the variation rate of stroke,the minimum diameter of the inferior vena cava(IVC),inferior vena cava expansion index and NT⁃proBNP.Analysis were performed according to the data properties.Result Groups of End⁃diastolic volume index of IVCDmin difference was statistically significant(P<0.05),and value of End⁃diastolic volume index group in IVCDmin were(1.57±0.32)cm.The optimal cut⁃off point for the smallest IVCDmin reflecting body volume deficiency was 1.35 cm,the sensitivity and specificity were 86.40%and 84.80%,respectively(P<0.01),and the optimal cutoff point of the minimum IVCDmin reflecting the body volume overload was 1.81 cm,the sensitivity and specificity were 76.50%and 89.60%,respectively(P<0.01).The gold standard of cutoff point for effective volume reactivity of inferior vena cava expansion index was 14.47%,sensitivity and specificity were 87.7%,81.0%(P<0.01).Conclusion In patients with sepsis under mechanical ventilation,when the IVCDmin was less than 1.35 cm,it should be paid to the state of insufficient blood volume.If the IVCDmin is greater than 1.81 cm,body volume overload should be early warned.And It should be evaluated timely of the body±s blood volume status and volume reactivity in order to accurately guide the fluid management.