超声监测下腔静脉直径及其塌陷指数在产后出血容量评估中的应用

Ultrasonic monitoring of inferior vena cava diameter and its collapse index in postpartum hemorrhage volume assessment

目的探讨床旁超声测量下腔静脉直径(IVCD)及其塌陷指数(IVCCI)评估产后出血(PPH)产妇容量的价值。方法采用前瞻性队列研究方法,选择2018年3月至2020年3月北京市海淀区妇幼保健院产后出血≥500 ml的剖宫产术后产妇43例,根据出血量分为两组,其中出血量500~1000 ml为A组,出血量>1000 ml为B组。应用床旁超声监测补液前后呼气末下腔静脉最大直径(Dmax)、吸气末下腔静脉最小直径(Dmin)及IVCCI,采用Pearson相关分析,分析各参数与中心静脉压(CVP)、出血量间的相关性。结果43例PPH中出血量500~1000 ml(A组)22例,出血量>1000 ml(B组)21例;补液前B组产妇IVCD和CVP明显低于A组,IVCCI明显高于A组(P<0.01);补液后两组IVCD、CVP均较补液前明显升高(P<0.05),两组补液后IVCCI较补液前显著降低(P<0.05);Dmax、Dmin与CVP呈正相关(r_(Dmax)=0.800,r_(Dmin)=0.873,P<0.01),IVCCI与CVP负相关(r_(IVCCI)=-0.732,P<0.01)。结论超声测量的IVCD与CVP呈正相关,能更准确评估PPH产妇容量状态。

Objective To investigate the value of bedside ultrasonic monitoring of inferior vena cava diameter(IVCD)and its collapse index(IVCCI)in assessing postpartum hemorrhage(PPH)volume.Methods A total of 43 puerpera undergoing cesarean section with PPH>500 ml in Beijing Haidian Maternal&Child Health Hospital from March 2018 to March 2020 were selected as study subjects of a prospective cohort study.They were divided into two groups according to the PPH volume,with PPH of 500-1000 ml in group A and PPH>1000 ml in group B.The inferior vena cava maximal diameter during quiet expiration(Dmax),the inferior vena cava minimal diameter during quiet inspiration(Dmin)and IVCCI were monitored by bedside ultrasound before and after rehydration,and the correlations of each parameter above with central venous pressure(CVP)and hemorrhage volume were analyzed by Pearson correlation analysis.Results Among 43 cases of PPH,there were 22 cases in group A(PPH=500-1000 ml)and 21 cases in group B(PPH>1000 ml).Before rehydration,IVCD and CVP were significantly smaller and IVCCI was significantly greater in group B than those in group A(P<0.01).IVCD and CVP were significantly greater in both groups after rehydration than those before rehydration(P<0.05).IVCCI was significantly smaller in two groups after rehydration than those before rehydration(P<0.05).Dmax and Dmin were positively correlated with CVP,(r_(Dmax)=0.800,r_(Dmin)=0.873,P<0.01),and IVCCI was negatively correlated with CVP,(r_(IVCCI)=-0.732,P<0.01).Conclusion IVCD measured by ultrasound is positively correlated with CVP and can more accurately assess the PPH volu me status.