IVC/Ao及颈动脉校正血流时间与脓毒症休克患者容量反应的关系及预测价值

Relationship and predictive value of the ratio of IVC/Ao and corrected carotid artery flow time with volumetric response in patients with septic shock

目的评估呼气末下腔静脉最大直径与心脏收缩期腹主动脉最大内径的比值(IVC/Ao)和颈动脉校正血流时间(FTc)对脓毒症休克患者容量反应的预测价值。方法纳入2020年6月至2023年6月西安市中心医院共86例脓毒症休克患者,采用经胸心脏超声监测容量负荷试验前后每搏输出量(SV),计算SV增加值(ΔSV)。容量反应阳性组(ΔSV≥15%)45例,男28例,女17例,年龄(63.21±6.95)岁;阴性组(ΔSV<15%)41例,男24例,女17例,年龄(64.17±7.24)岁。记录下腔静脉塌陷指数(IVCCI)、IVC/Ao、试验前后平均动脉压(MAP)、中心静脉压(CVP)、心率、FTc及颈动脉峰流速变异度(ΔVpeak-CA)。分析容量负荷试验前IVC/Ao、FTc、ΔVpeak-CA与ΔSV的相关性,采用受试者操作特征曲线(ROC)分析这几项指标对脓毒症休克患者容量反应阳性的预测价值。统计学方法采用χ^(2)检验、t检验。结果阳性组患者试验后FTc较试验前升高(t=4.63,P<0.001)。试验前阳性组患者IVCCI、IVC/Ao和ΔVpeak-CA均高于阴性组[(28.77±3.36)比(14.20±3.87)、(1.55±0.16)比(1.19±0.12)、(12.81±4.59)%比(8.04±4.29)%],差异均有统计学意义(t=18.68、11.71、4.97,均P<0.05)。ΔSV与FTc呈负相关,与IVC/Ao、ΔVpeak-CA和IVCCI均呈正相关(均P<0.001)。列线图模型结果显示,FTc水平较高及IVC/Ao、ΔVpeak-CA和IVCCI水平较低患者容量反应阴性的风险更高。ROC分析显示,几项指标联合预测容量反应的曲线下面积(AUC)为0.946。结论IVC/Ao和颈动脉FTc是预测脓毒症休克患者容量反应阳性的有效指标,可以作为临床上判断脓毒症休克患者是否需要液体复苏的有用工具。

Objective To evaluate the value of the ratio of the maximum diameter of the inferior vena cava at end-expiration(IVCmax)to the maximum internal diameter of the abdominal aorta during systole(IVC/Ao)and the corrected flow time of the carotid artery(FTc)in predicting volumetric response in patients with septic shock.Methods A total of 86 patients with septic shock were included in Xi'an Central Hospital from June 2020 to June 2023,and the stroke output(SV)before and after the volume loading test was monitored by transthoracic echocardiography,and the SV added value(ΔSV)was calculated.In the volume-responsive group(ΔSV≥15%),there were 28 males and 17 females,aged(63.21±6.95)years.In the non-responsive group(ΔSV<15%),there were 24 males and 17 females,aged(64.17±7.24)years.The IVC/Ao,mean arterial pressure(MAP),central venous pressure(CVP),heart rate,FTc,and variation in peak carotid artery flow velocity(ΔVpeak-CA)were recorded before and after the test.The correlations between IVC/Ao,FTc,ΔVpeak-CA,andΔSV before the test were analyzed.Their predictive value for volume responsiveness in septic shock patients was analyzed by receiver operating characteristic curve(ROC).Statistical methods used wereχ^(2) test and t test.Results The FTc in the responsive group was higher after the test than that before the test(t=4.63,P<0.001).Before the test,the inferior vena cava collapse index(IVCCI),IVC/Ao,andΔVpeak-CA in the responsive group were higher than those in the non-responsive group[(28.77±3.36)vs.(14.20±3.87),(1.55±0.16)vs.(1.19±0.12),and(12.81±4.59)%vs.(8.04±4.29)%],with statistically significant differences(t=18.68,11.71,and 4.97,all P<0.05).ΔSV was negatively correlated with FTc and was positively correlated with IVC/Ao,ΔVpeak-CA,and IVCCI(all P<0.001).Nomogram model results suggested a higher risk of volume non-responsiveness in patients with higher FTc level and lower IVC/Ao,ΔVpeak-CA,and IVCmax levels.ROC analysis indicated that the combined predictive value of these indicators for volume responsiveness had an area under the curve(AUC)of 0.946.Conclusion The IVC/Ao ratio and carotid FTc are effective predictors of volume responsiveness in septic shock patients and can be utilized as valuable clinical tools for determining the need for fluid resuscitation in these patients.