下腔静脉直径变异率在神经重症监护病房患者容量反应评估中的应用

Application of respiratory variability of inferior vena cava internal diameter in fluid responsiveness evaluation of patients in neuro-intensive care unit

目的探讨下腔静脉直径变异率在神经重症监护病房患者容量反应评估中的应用价值。方法将2021年1—12月在广州医科大学附属第六医院神经重症监护病房接受治疗的120例患者为研究对象,所有患者均抽取动脉血气分析检测乳酸等数据,通过床旁超声检测下腔静脉直径的变异率,通过唯捷流检测心排量等血流动力学参数,所有患者均接受容量负荷试验,根据患者有无容量反应性将其分为A组(有容量反应性,n=65)和B组(无容量反应性,n=55),比较两组间患者的下腔静脉直径的变异率差异以及补液前后有关血流动力学指标的变异率,分析并评估下腔静脉直径的变异率和有无容量反应的相关性。结果A组患者的中心静脉压变异率小于B组,差异有统计学意义(P<0.05);A组的下腔静脉直径变异率、心脏指数变异率、每搏输出量变异率、舒张压变异率、收缩压变异率、脉压差变异率均大于B组,差异有统计学意义(P<0.05)。经分析下腔静脉直径变异率和容量反应性指标的相关性,结果提示患者下腔静脉直径变异率和中心静脉压变异率、舒张压变异率均无明显相关性(P>0.05),而与心脏指数变异率、每搏输出量变异率、收缩压变异率、脉压差变异率呈正相关(P<0.05)。结论神经重症监护病房患者的容量反应与下腔静脉直径变异率存在相关性,通过床旁超声测量下腔静脉直径变异率可对神经重症监护病房患者容量反应进行快捷、有效的评估,在重症患者的诊治中有较大的临床意义。

Objective To investigate the application value of respiratory variability of inferior vena cava(IVC)internal diameter in fluid responsiveness evaluation of patients in neuro-intensive care unit.Methods A total of 120 patients admitted to the neuro-intensive care unit of the Sixth Affiliated Hospital of Guangzhou Medical University from January to December 2021 were taken as the main research objects.Baseline data(such as arterial blood lactic acid)were collected from all patients,and the respiratory variability of the IVC internal diameter was measured by ultrasound,and hemodynamic parameters such as cardiac output and stroke volume were monitored.Then all patients underwent volume load test.Patients were divided into group A(with fluid responsiveness,n=65)and group B(without fluid responsiveness,n=55)according to whether they had fluid responsiveness.The differences of respiratory variability of IVC internal diameter of the patients between the two groups and the variability of hemodynamic indices before and after fluid infusion were compared,and the correlation between respiratory variability of the IVC internal diameter and fluid responsiveness indices was analyzed and evaluated.Results The variability of central venous pressure in group A was lower than that in group B,with statistically significant difference(P<0.05).The respiratory variability of IVC internal diameter,and the variabilities of systolic blood pressure,diastolic blood pressure,pulse pressure difference,stroke volume and cardiac index in group A were all higher than those in group B,with statistically significant differences(P<0.05).By analyzing the correlation between the respiratory variability of IVC internal diameter and fluid responsiveness index,the results showed that the respiratory variability of IVC internal diameter and the variabilities of central venous pressure and diastolic pres sure were all not significantly correlated(P>0.05),but the respiratory variability of IVC internal diameter was positively correlated with variabilities of systolic blood pressure,pulse pressure difference,stroke volume and cardiac index(P<0.05).Conclusion There is a close correlation between the fluid responsiveness and the respiratory variability of the IVC internal diameter of patients in the neuro-intensive care unit.With the respiratory variability of the IVC internal diameter measured by ultrasound,the fluid responsiveness of patients in the neuro-intensive care unit can be effectively and accurately evaluated,thus providing scientific guidance for patients’subsequent treatment plans.