颈内静脉塌陷指数评价脓毒症患者容量反应性的可行性分析
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摘要
目的分析颈内静脉塌陷指数作为下腔静脉塌陷指数的辅助手段评价自主呼吸的脓毒症患者容量反应性的可行性。方法应用床旁彩超对自主呼吸的脓毒症患者于基线状态和快速补液试验后分别测量下腔静脉塌陷指数和颈内静脉塌陷指数。根据患者对补液试验的反应不同,分为有反应组(22例)和无反应组(21例)进行对比分析。结果基线状态下有反应组IJV-CI[(36.62±9.01)%比(24.72±8.17)%,P <0.001],IVC-CI[(38.96±8.25)%比(26.61±7.52)%,P <0.001]均显著无反应组,差异均有统计学意义。补液试验后两组IJV-CI与IVCCI比较,差异均无统计学差异。Spearman相关分析结果提示:颈内静脉塌陷率(IJV-CI)与下腔静脉塌陷率(IVC-CI)在有反应组(r=0.635,P=0.008)和无反应组(r=0.912,P=0.001)均呈正相关。结论对于未行机械通气的脓毒症患者,颈内静脉塌陷指数是一种容易获得的非侵入性容量反应性参数,可以作为下腔静脉塌陷指数的有益补充。
Objective To analyze the feasibility of jugular vein collapse index as an adjunct to inferior vena cava collapse index to evaluate the volume reactivity of sepsis patients with spontaneous respiration.Methods Bedside color Doppler ultrasound was used to measure the inferior vena cava collapse index and internal jugular vein collapse index in patients with spontaneously breathing sepsis after baseline and rapid fluid replacement test.According to the patients' response to the rehydration test,they were divided into a reaction group(22 cases)and a non-reaction group(21 cases)for comparative analysis.Results In the baseline state,there were reaction group IJV-CI[(36.62±9.01)%ratio(24.72±8.17)%,P <0.001],IVC-CI[(38.96±8.25)% ratio(26.61±7.52)%,P <0.001]were significantly unresponsive groups,and the differences were statistically significant.There was no significant difference in IJV-CI and IVC-CI between the two groups after the fluid replacement test.Spearman correlation analysis showed that the internal jugular vein collapse rate(IJV-CI)and the inferior vena cava collapse rate(IVC-CI)were in the reaction group(r=0.635,P =0.008)and the non-reaction group(r=0.912,P =0.001)are positively correlated.Conclusion For patients with sepsis who are not mechanically ventilated,the internal jugular vein collapse index is a readily available non-invasive volume response parameter that can be a useful complement to the inferior vena cava collapse index.
Objective To analyze the feasibility of jugular vein collapse index as an adjunct to inferior vena cava collapse index to evaluate the volume reactivity of sepsis patients with spontaneous respiration.Methods Bedside color Doppler ultrasound was used to measure the inferior vena cava collapse index and internal jugular vein collapse index in patients with spontaneously breathing sepsis after baseline and rapid fluid replacement test.According to the patients' response to the rehydration test,they were divided into a reaction group(22 cases)and a non-reaction group(21 cases)for comparative analysis.Results In the baseline state,there were reaction group IJV-CI[(36.62±9.01)%ratio(24.72±8.17)%,P <0.001],IVC-CI[(38.96±8.25)% ratio(26.61±7.52)%,P <0.001]were significantly unresponsive groups,and the differences were statistically significant.There was no significant difference in IJV-CI and IVC-CI between the two groups after the fluid replacement test.Spearman correlation analysis showed that the internal jugular vein collapse rate(IJV-CI)and the inferior vena cava collapse rate(IVC-CI)were in the reaction group(r=0.635,P =0.008)and the non-reaction group(r=0.912,P =0.001)are positively correlated.Conclusion For patients with sepsis who are not mechanically ventilated,the internal jugular vein collapse index is a readily available non-invasive volume response parameter that can be a useful complement to the inferior vena cava collapse index.
引文
[1]Rhodes A,Evans LE,Alhazzani W,et al.Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and Septic Shock:2016[J].Intensive Care Med,2017,43(3):304-377.
[2]Acheampong A,Vincent JL.A positive fluid balance is an independent prognostic factor in patients with sepsis[J].Crit Care,2015,19:251.
[3]Preau S,Bortolotti P,Colling D,et al.Diagnostic Accuracy of the Inferior Vena Cava Collapsibility to Predict Fluid Responsiveness in Spontaneously Breathing Patients With Sepsis and Acute Circulatory Failure[J].Crit Care Med,2017,45(3):e290-e297.
[4]Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):801-10.
[5]Torres C,Hogan M,Patro S,et al.Extracranial Venous abnormalities:A true pathological finding in patients with multiple sclerosis or an anatomical variant[J].Eur Radiol,2017,27(1):239-246.
[2]Acheampong A,Vincent JL.A positive fluid balance is an independent prognostic factor in patients with sepsis[J].Crit Care,2015,19:251.
[3]Preau S,Bortolotti P,Colling D,et al.Diagnostic Accuracy of the Inferior Vena Cava Collapsibility to Predict Fluid Responsiveness in Spontaneously Breathing Patients With Sepsis and Acute Circulatory Failure[J].Crit Care Med,2017,45(3):e290-e297.
[4]Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):801-10.
[5]Torres C,Hogan M,Patro S,et al.Extracranial Venous abnormalities:A true pathological finding in patients with multiple sclerosis or an anatomical variant[J].Eur Radiol,2017,27(1):239-246.