被动下肢抬高试验联合颈动脉校正血流时间在评估正常成人血容量状态中的应用价值

Application value of passive leg raising test combined with carotid artery corrected flow time in assessment of blood volume status among normal adults

目的探讨被动下肢抬高试验(PLR)联合颈动脉校正血流时间(FTc)在评估正常成人血容量状态中的应用价值。方法选取563名正常成年人,应用颈动脉超声测量PLR前后的颈动脉血流时间,并计算FTc。比较不同性别正常成人PLR前后右侧颈动脉FTc的差异,以及PLR前后左右两侧颈动脉之间FTc的差异,并分析PLR前右侧颈动脉FTc值的影响因素。结果(1)正常成人PLR前右侧颈动脉FTc为(328.81±12.63)ms。(2)正常成年女性PLR前及PLR后的右侧颈动脉FTc均长于男性,且正常成年男性及女性PLR后的右侧颈动脉FTc值均长于PLR前(均P<0.05),但正常成年男性及女性PLR前后右侧颈动脉FTc的差值差异无统计学意义(P>0.05)。(3)正常成人PLR前后左、右两侧之间颈动脉FTc比较,差异均无统计学意义(均P>0.05),但PLR后的左、右两侧颈动脉FTc均较PLR前明显增加(均P<0.05)。(4)多元线性回归分析结果显示,性别是PLR前右侧脉颈动脉FTc的影响因素(P<0.05)。结论颈动脉FTc值结合PLR试验可敏感地发现血容量的微小变化,正常成人PLR前右侧颈动脉FTc及PLR前后FTc变化或可为重症患者血容量状态及容量反应性的评估提供参考;性别是PLR前右侧颈动脉FTc的主要影响因素,应该针对不同性别确定不同的颈动脉FTc正常值范围。

Objective To explore the application value of passive leg raising(PLR) test combined with carotid artery corrected flow time(FTc) in the assessment of blood volume status among normal adults.Methods A total of 563 normal adults were selected,carotid artery ultrasound was employed to measure carotid artery blood flow time before and after PLR,and FTc was calculated.The differences in right carotid artery FTc were compared between normal male and female adults before and after PLR,and the differences in FTc were compared between left and right carotid arteries before and after PLR.In addition,the influencing factors of right carotid artery FTc before PLR were analyzed.Results(1)The right carotid artery FTc before PLR was 328.81±12.63 ms in normal adults.(2) Normal female adults had longer right carotid artery FTc before and after PLR than male adults,and right carotid artery FTc in normal male or female adults after PLR was higher than that before PLR(all P<0.05),but no statistically significant difference was found in right carotid artery FTc before or after PLR between normal male and female adults(P>0.05).(3) Left or right carotid artery FTc before and after PLR showed no statistically significant difference in normal adults(all P>0.05),whereas both left and right carotid artery FTc after PLR were significantly increased than those before PLR(all P<0.05).(4) Multiple linear regression analysis results revealed that gender was an influencing factor of right carotid artery FTc before PLR(P<0.05).Conclusion Carotid artery FTc can discover minor changes in blood volume sensitively in combination with PLR test.Right carotid artery FTc of normal adults before PLR as well as the variations in FTc before and after PLR may provide the references for assessing blood volume status and volume responsiveness in severe patients.Gender is a primary influencing factor of right carotid artery FTc before PLR,so it is necessary to define the different normal ranges of carotid artery FTc in male and female adults.