下腔静脉超声评估在低血容量患者液体复苏中的作用研究

Study on the Role of Ultrasound Evaluation of the Inferior Vena Cava in Fluid Resuscitation in Patients with Hypovolemia

目的:探讨下腔静脉(IVC)超声评估在低血容量患者液体复苏中的作用。方法:回顾性分析本院2018年7月-2020年7月50例低血容量患者的临床资料,将2018年7月-2019年6月采取中心静脉压(CVP)容量负荷试验为液体复苏标准的25例低血容量患者设为对照组,将2019年7月-2020年7月采用超声下检测下腔静脉呼吸变异度(IVC-RVI)为复苏标准的25例患者设为研究组。比较两组临床疗效、并发症发生情况及复苏3、4、6 h的平均动脉压(MAP)、乳酸清除率、尿量。结果:两组临床疗效比较,差异无统计学意义(P>0.05)。研究组总有效率虽高于对照组,但差异无统计学意义(P>0.05)。复苏3 h,两组MAP、乳酸清除率、尿量比较,差异均无统计学意义(P>0.05)。复苏4、6 h,两组MAP、乳酸清除率、尿量均高于复苏3 h,且研究组均高于对照组,差异均有统计学意义(P<0.05)。研究组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:超声下连续监测IVC-RVI作为无创监测方式,能够准确评估低血容量患者容量反应性,促进液体复苏起效,且具有良好安全性。

Objective:To investigate the role of ultrasound evaluation of the inferior vena cava (IVC) in fluid resuscitation in patients with hypovolemia.Method:Clinical data of 50 patients with hypovolemia in our hospital from July 2018 to July 2020 were retrospectively analyzed,25 patients with hypovolemia who underwent central venous pressure (CVP) volume loading test as fluid resuscitation standard from July 2018 to June 2019 were enrolled as the control group,25 patients who were resuscitated with respiratory variation index of inferior vena cava (IVC-RVI) under ultrasound from July 2019 to July 2020 were enrolled as the study group.The clinical efficacy,incidence of complications were compared between two groups,mean arterial pressure (MAP),lactate clearance rate and urine volume at 3,4 and 6 h of resuscitation were compared between two groups.Result:There was no significant difference in clinical efficacy between the two groups (P>0.05).The total effective rate of the study group was higher than that of the control group,but the difference was not statistically significant (P>0.05).3 h of resuscitation,there were no significant differences in MAP,lactic acid clearance rate and urine volume between two groups (P>0.05).4,6 h of resuscitation,the MAP,lactic acid clearance rate and urine volume of both groups were higher than those of 3 h of resuscitation,and those of the study group were higher than those of the control group,the differences were statistically significant (P<0.05).The incidence of complications of the study group was lower than that of the control group,the difference was statistically significant (P<0.05).Conclusion:Continuous monitoring of IVC-RVI under ultrasound,as a non-invasive monitoring method,can accurately evaluate the volume reactivity of patients with hypovolemia,promote the effectiveness of fluid resuscitation,and has good safety.