床旁超声评估成年危重症患者血容量状态之应用研究新进展

Progress of ultrasound in volume stadus assessment of critically ill patients

急危重症患者常存在血流动力学不稳定,需精细液体管理。床旁超声检查具有准确、及时、迅速等诸多优势,可随病情变化反复检查及评估。随着床旁超声的临床深度应用及其深入研究,目前相关研究发现下腔静脉直径大小可反映机体血容量状态,自主呼吸状态下,下腔静脉塌陷指数>50%提示具有容量反应性,机械通气下,下腔静脉扩张指数>26%提示有容量反应性。妊娠妇女结果则略有不同,妊娠妇女左侧卧位下腔静脉塌陷指数>25.64%提示血容量不足。食管超声下观察上腔静脉塌陷指数>37%提示有容量反应性。床旁超声可全方位监测及评估血容量状态,可及时、有效地指导急危重症患者液体管理。

Critically ill patients often have hemodynamic instability and require fine fluid management.Ultrasound has many advantages,such as accuracy,timeliness,rapidity,etc.,and can be repeatedly examined and evaluated of the change of the disease.With the depth of the clinical application and research of ultrasound,the current research found that the inferior vena cava diameter size could responsed the blood volume status.In spontaneous breathing state,the collapse of the inferior vena cava index greater than 50%had indicated of volumetric reactivity,and in mechanical ventilation,the inferior vena cava expansion index greater than 26%had indicated of volumetric reactivity.The results were different for pregnant women,and the collapse index in left of inferior vena cava of pregnant women greater than 25.64%had suggested hypovolemia.The collapse index of superior vena cava under esophageal ultrasonography>37%had been suggested that had volume reactivity.Ultrasound can monitor and assess blood volume status comprehensively,and it can be widely used to guide the liquid management of the patients in time and effectively.