Point-of-care ultrasound has been increasingly used in evaluating shocked patients including the measurement of inferior vena cava(IVC) diameter. Operators should standardize their technique in scanning IVC. Relativec...Point-of-care ultrasound has been increasingly used in evaluating shocked patients including the measurement of inferior vena cava(IVC) diameter. Operators should standardize their technique in scanning IVC. Relativechanges are more important than absolute numbers. We advise using the longitudinal view(B mode) to evaluate the gross collapsibility, and the M mode to measure the IVC diameter. Combining the collapsibility and diameter size will increase the value of IVC measurement. This approach has been very useful in the resuscitation of shocked patients, monitoring their fluid demands, and predicting recurrence of shock. Pitfalls in measuring IVC diameter include increased intra-thoracic pressure by mechanical ventilation or increased right atrial pressure by pulmonary embolism or heart failure. The IVC diameter is not useful in cases of increased intra-abdominal pressure(abdominal compartment syndrome) or direct pressure on the IVC. The IVC diameter should be combined with focused echocardiography and correlated with the clinical picture as a whole to be useful.展开更多
We have previously reported that the maximal inferior vena cava(IVC) diameter during quiet expiration(IVCe) measured by ultrasonography correlates well with the amount of body fluid, especially the circulating blo... We have previously reported that the maximal inferior vena cava(IVC) diameter during quiet expiration(IVCe) measured by ultrasonography correlates well with the amount of body fluid, especially the circulating blood volume[1] and proposed using the criteria of IVC diameter to determine dry weight(DW) in anuric hemodialyzed (HD) patients: standard IVCe of pre-and post-HD are (14.9±0.4) and (8.2±0.3) mm, respectively[2]. However, the same post-HD IVC criterion should not be applied to nonoliguric HD patients because it could result in rapid deterioration of residual renal function due to forced dehydration. Although the biochemical DW marker plasma atrial natriuretic peptide (ANP) is useful to evaluate hypervolemia but not hypovolemia,both hyper-and hypovolemia can be detected by IVC measurement.……展开更多
The IVC diameters in HD patients
Since BW and stature as well as gender and age were not considered to be determinant factors of the IVC diameters, these factors were not accounted for in evaluating the IVC d... The IVC diameters in HD patients
Since BW and stature as well as gender and age were not considered to be determinant factors of the IVC diameters, these factors were not accounted for in evaluating the IVC diameters in HD patients. The IVC diameters of stable anuric HD patients are shown in Table 2. In agreement with our previous observation [7-9] ,the reduction of BW from (51.7±12.6) to (49.3±12.6)kg by ultrafiltration during HD resulted in a significant (P<0.0001)reduction of the IVCe and IVCi from (14.9 ± 3.2) to (6.8±1.9)mm and (5.2±4.2) to (0.1±0.3) mm,respectively. Thus,CI values before and at the end of HD were calculated as (0.68±0.24) and (0.98±0. 05), respectively (P<0.0001).
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目的:分析超声检测下腔静脉(IVC)和锁骨下静脉(SCV)内径变异在预测全麻诱导后低血压(PIH)中的价值。方法:回顾性选取2021年5月—2023年5月在咸宁市第一人民医院行全麻手术的204例患者作为研究对象,根据是否发生PIH将其分为研究组(发生PI...目的:分析超声检测下腔静脉(IVC)和锁骨下静脉(SCV)内径变异在预测全麻诱导后低血压(PIH)中的价值。方法:回顾性选取2021年5月—2023年5月在咸宁市第一人民医院行全麻手术的204例患者作为研究对象,根据是否发生PIH将其分为研究组(发生PIH,86例)和对照组(未发生PIH,118例)。对两组患者的基础资料、麻醉诱导前血压、麻醉诱导药物用量进行对比。比较IVC内径的最大值(IVCmax)和最小值(IVCmin)、SCV内径的最大值(SCVmax)和最小值(SCVmin),并计算IVC塌陷指数(IVCCI)和SCV塌陷指数(SCVCI)。采用受试者工作特征(ROC)曲线分析IVC、SCV内径及变异对全麻PIH的预测价值。结果:两组基础资料、麻醉诱导前血压指标和麻醉诱导药物用量比较,差异均无统计学意义(P>0.05)。研究组IVCmax、IVCmin、SCVmax、SCVmin水平均低于对照组,IVCCI、SCVCI水平均高于对照组,差异均有统计学意义(P<0.05)。受试者操作特征(ROC)曲线分析结果显示,麻醉诱导前IVCmax、IVCmin、SCVmax、SCVmin、IVCCI、SCVCI水平预测PIH的ROC曲线下面积(area under curve,AUC)分别为0.674、0.675、0.618、0.707、0.895、0.905,其中,SCVCI的AUC和cut-off值下的敏感度均为最高,分别为0.905、65.12%。结论:全麻PIH患者可表现为IVC和SCV内径缩小及IVCCI、SCVCI等内径变异指标的增高,采用血管超声技术检测上述变异指标可辅助预测PIH风险。展开更多
目的探讨静脉-动脉二氧化碳含量差/动脉-静脉氧含量差(Cv-a CO2/Ca-v O2)、乳酸清除率(LCR)与下腔静脉内径呼吸变异指数(IVCrvi)作为脓毒症休克患者早期复苏终点指标的可行性及价值。方法选取2016年6月至2018年2月该院收治的脓毒性休克...目的探讨静脉-动脉二氧化碳含量差/动脉-静脉氧含量差(Cv-a CO2/Ca-v O2)、乳酸清除率(LCR)与下腔静脉内径呼吸变异指数(IVCrvi)作为脓毒症休克患者早期复苏终点指标的可行性及价值。方法选取2016年6月至2018年2月该院收治的脓毒性休克患者60例,均进行早期液体复苏治疗,应用Cv-a CO2/Ca-v O2、LCR、IVCrvi进行评估,以尿量大于0.5 m L/(kg·h)、平均动脉压大于65 mm Hg(1 mm Hg=0.133 k Pa)为达标,根据达标情况将患者分为达标组和未达标组。结果复苏治疗后所有患者Cv-a CO2/Ca-v O2、LCR及IVCrvi等指标均得到明显改善,达标组患者指标改善情况优于未达标组,差异均有统计学意义(P<0.05)。结论脓毒症休克患者早期复苏治疗可应用Cv-a CO2/Ca-v O2、LCR、IVCrvi进行评估,其对复苏治疗有重要指导价值。展开更多
文摘Point-of-care ultrasound has been increasingly used in evaluating shocked patients including the measurement of inferior vena cava(IVC) diameter. Operators should standardize their technique in scanning IVC. Relativechanges are more important than absolute numbers. We advise using the longitudinal view(B mode) to evaluate the gross collapsibility, and the M mode to measure the IVC diameter. Combining the collapsibility and diameter size will increase the value of IVC measurement. This approach has been very useful in the resuscitation of shocked patients, monitoring their fluid demands, and predicting recurrence of shock. Pitfalls in measuring IVC diameter include increased intra-thoracic pressure by mechanical ventilation or increased right atrial pressure by pulmonary embolism or heart failure. The IVC diameter is not useful in cases of increased intra-abdominal pressure(abdominal compartment syndrome) or direct pressure on the IVC. The IVC diameter should be combined with focused echocardiography and correlated with the clinical picture as a whole to be useful.
文摘 We have previously reported that the maximal inferior vena cava(IVC) diameter during quiet expiration(IVCe) measured by ultrasonography correlates well with the amount of body fluid, especially the circulating blood volume[1] and proposed using the criteria of IVC diameter to determine dry weight(DW) in anuric hemodialyzed (HD) patients: standard IVCe of pre-and post-HD are (14.9±0.4) and (8.2±0.3) mm, respectively[2]. However, the same post-HD IVC criterion should not be applied to nonoliguric HD patients because it could result in rapid deterioration of residual renal function due to forced dehydration. Although the biochemical DW marker plasma atrial natriuretic peptide (ANP) is useful to evaluate hypervolemia but not hypovolemia,both hyper-and hypovolemia can be detected by IVC measurement.……
文摘 The IVC diameters in HD patients
Since BW and stature as well as gender and age were not considered to be determinant factors of the IVC diameters, these factors were not accounted for in evaluating the IVC diameters in HD patients. The IVC diameters of stable anuric HD patients are shown in Table 2. In agreement with our previous observation [7-9] ,the reduction of BW from (51.7±12.6) to (49.3±12.6)kg by ultrafiltration during HD resulted in a significant (P<0.0001)reduction of the IVCe and IVCi from (14.9 ± 3.2) to (6.8±1.9)mm and (5.2±4.2) to (0.1±0.3) mm,respectively. Thus,CI values before and at the end of HD were calculated as (0.68±0.24) and (0.98±0. 05), respectively (P<0.0001).
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文摘目的:分析超声检测下腔静脉(IVC)和锁骨下静脉(SCV)内径变异在预测全麻诱导后低血压(PIH)中的价值。方法:回顾性选取2021年5月—2023年5月在咸宁市第一人民医院行全麻手术的204例患者作为研究对象,根据是否发生PIH将其分为研究组(发生PIH,86例)和对照组(未发生PIH,118例)。对两组患者的基础资料、麻醉诱导前血压、麻醉诱导药物用量进行对比。比较IVC内径的最大值(IVCmax)和最小值(IVCmin)、SCV内径的最大值(SCVmax)和最小值(SCVmin),并计算IVC塌陷指数(IVCCI)和SCV塌陷指数(SCVCI)。采用受试者工作特征(ROC)曲线分析IVC、SCV内径及变异对全麻PIH的预测价值。结果:两组基础资料、麻醉诱导前血压指标和麻醉诱导药物用量比较,差异均无统计学意义(P>0.05)。研究组IVCmax、IVCmin、SCVmax、SCVmin水平均低于对照组,IVCCI、SCVCI水平均高于对照组,差异均有统计学意义(P<0.05)。受试者操作特征(ROC)曲线分析结果显示,麻醉诱导前IVCmax、IVCmin、SCVmax、SCVmin、IVCCI、SCVCI水平预测PIH的ROC曲线下面积(area under curve,AUC)分别为0.674、0.675、0.618、0.707、0.895、0.905,其中,SCVCI的AUC和cut-off值下的敏感度均为最高,分别为0.905、65.12%。结论:全麻PIH患者可表现为IVC和SCV内径缩小及IVCCI、SCVCI等内径变异指标的增高,采用血管超声技术检测上述变异指标可辅助预测PIH风险。
文摘目的探讨静脉-动脉二氧化碳含量差/动脉-静脉氧含量差(Cv-a CO2/Ca-v O2)、乳酸清除率(LCR)与下腔静脉内径呼吸变异指数(IVCrvi)作为脓毒症休克患者早期复苏终点指标的可行性及价值。方法选取2016年6月至2018年2月该院收治的脓毒性休克患者60例,均进行早期液体复苏治疗,应用Cv-a CO2/Ca-v O2、LCR、IVCrvi进行评估,以尿量大于0.5 m L/(kg·h)、平均动脉压大于65 mm Hg(1 mm Hg=0.133 k Pa)为达标,根据达标情况将患者分为达标组和未达标组。结果复苏治疗后所有患者Cv-a CO2/Ca-v O2、LCR及IVCrvi等指标均得到明显改善,达标组患者指标改善情况优于未达标组,差异均有统计学意义(P<0.05)。结论脓毒症休克患者早期复苏治疗可应用Cv-a CO2/Ca-v O2、LCR、IVCrvi进行评估,其对复苏治疗有重要指导价值。
