中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
2期
133-136
,共4页
王海峰%刘笑雷%陆海涛%齐志伟%闫圣涛%顾承东%张国强
王海峰%劉笑雷%陸海濤%齊誌偉%閆聖濤%顧承東%張國彊
왕해봉%류소뢰%륙해도%제지위%염골도%고승동%장국강
超声检查%脓毒症休克%下腔静脉%血流动力学%脉搏指示连续心排出量%液体复苏
超聲檢查%膿毒癥休剋%下腔靜脈%血流動力學%脈搏指示連續心排齣量%液體複囌
초성검사%농독증휴극%하강정맥%혈류동역학%맥박지시련속심배출량%액체복소
Ultrasonogrphy%Septic shock%Inferior vena cava%Hemodynamics%Pulse-indicatedcontinuous cardiacoutput%Fluid resuscitation
目的 探讨脓毒症休克时下腔静脉管径及呼吸变异指数与脉搏指示连续心排出量(PiCCO)血流动力学指标的关系.方法 取8只幼年猪,颈内静脉推注大肠杆菌内毒素(LPS,100tμg/kg)制作脓毒症休克模型,出模后予生理盐水进行液体复苏.分别在动物模型制作前、休克时、液体复苏1h及6h时点超声探测下腔静脉最大径(IVCmax)、最小径(IVCmin)并计算呼吸变异指数(IVCrvi),同时记录PiCCO血流动力学指标,包括:胸廓内血容量(ITBV)、全心舒张末容积(GEDV)、每搏输出量变异指数(SVV)和心脏指数(CI).采LSD-t检验比较液体复苏前后IVCmax、IVCmin、IVCrvi及PiCCO血流动力学指标的变化；采用Pearson相关性分析了解IVCmax、IVCmin及IVCrvi与PiCCO血流动力学指标的相关性.结果 液体复苏1 h IVCmax、IVC min、GEDV、ITBV及CI均显著大于休克时(P＜0.01),SVV及IVCrvi均显著小于休克时(P＜0.01)；液体复苏6 h IVCmax、IWCmin、GEDV、ITBV及CI均显著大于休克时(P＜0.01)及液体复苏1h(P＜0.01),SVV及IVCrvi均显著小于休克时(P＜0.01)及液体复苏1 h(P＜0.01).IVCmax与SVV有相关性(P =0.024),与GEDV、ITBV及CI无相关性；IVCmin与SVV、GEDV、ITBV及CI均有相关性(分别P=0.009、P=0.003、P=0.001和P=0.015)；IVCrvi与SVV、GEDV、ITBV及CI均有相关性(分别P=0.007、P＜0.01、P＜0.01和P＜0.01).结论 下腔静脉管径及呼吸变异指数与PiCC0血流动力学指标具有相关性,可以为临床医师快速评估血容量提供依据.
目的 探討膿毒癥休剋時下腔靜脈管徑及呼吸變異指數與脈搏指示連續心排齣量(PiCCO)血流動力學指標的關繫.方法 取8隻幼年豬,頸內靜脈推註大腸桿菌內毒素(LPS,100tμg/kg)製作膿毒癥休剋模型,齣模後予生理鹽水進行液體複囌.分彆在動物模型製作前、休剋時、液體複囌1h及6h時點超聲探測下腔靜脈最大徑(IVCmax)、最小徑(IVCmin)併計算呼吸變異指數(IVCrvi),同時記錄PiCCO血流動力學指標,包括:胸廓內血容量(ITBV)、全心舒張末容積(GEDV)、每搏輸齣量變異指數(SVV)和心髒指數(CI).採LSD-t檢驗比較液體複囌前後IVCmax、IVCmin、IVCrvi及PiCCO血流動力學指標的變化；採用Pearson相關性分析瞭解IVCmax、IVCmin及IVCrvi與PiCCO血流動力學指標的相關性.結果 液體複囌1 h IVCmax、IVC min、GEDV、ITBV及CI均顯著大于休剋時(P＜0.01),SVV及IVCrvi均顯著小于休剋時(P＜0.01)；液體複囌6 h IVCmax、IWCmin、GEDV、ITBV及CI均顯著大于休剋時(P＜0.01)及液體複囌1h(P＜0.01),SVV及IVCrvi均顯著小于休剋時(P＜0.01)及液體複囌1 h(P＜0.01).IVCmax與SVV有相關性(P =0.024),與GEDV、ITBV及CI無相關性；IVCmin與SVV、GEDV、ITBV及CI均有相關性(分彆P=0.009、P=0.003、P=0.001和P=0.015)；IVCrvi與SVV、GEDV、ITBV及CI均有相關性(分彆P=0.007、P＜0.01、P＜0.01和P＜0.01).結論 下腔靜脈管徑及呼吸變異指數與PiCC0血流動力學指標具有相關性,可以為臨床醫師快速評估血容量提供依據.
목적 탐토농독증휴극시하강정맥관경급호흡변이지수여맥박지시련속심배출량(PiCCO)혈류동역학지표적관계.방법 취8지유년저,경내정맥추주대장간균내독소(LPS,100tμg/kg)제작농독증휴극모형,출모후여생리염수진행액체복소.분별재동물모형제작전、휴극시、액체복소1h급6h시점초성탐측하강정맥최대경(IVCmax)、최소경(IVCmin)병계산호흡변이지수(IVCrvi),동시기록PiCCO혈류동역학지표,포괄:흉곽내혈용량(ITBV)、전심서장말용적(GEDV)、매박수출량변이지수(SVV)화심장지수(CI).채LSD-t검험비교액체복소전후IVCmax、IVCmin、IVCrvi급PiCCO혈류동역학지표적변화；채용Pearson상관성분석료해IVCmax、IVCmin급IVCrvi여PiCCO혈류동역학지표적상관성.결과 액체복소1 h IVCmax、IVC min、GEDV、ITBV급CI균현저대우휴극시(P＜0.01),SVV급IVCrvi균현저소우휴극시(P＜0.01)；액체복소6 h IVCmax、IWCmin、GEDV、ITBV급CI균현저대우휴극시(P＜0.01)급액체복소1h(P＜0.01),SVV급IVCrvi균현저소우휴극시(P＜0.01)급액체복소1 h(P＜0.01).IVCmax여SVV유상관성(P =0.024),여GEDV、ITBV급CI무상관성；IVCmin여SVV、GEDV、ITBV급CI균유상관성(분별P=0.009、P=0.003、P=0.001화P=0.015)；IVCrvi여SVV、GEDV、ITBV급CI균유상관성(분별P=0.007、P＜0.01、P＜0.01화P＜0.01).결론 하강정맥관경급호흡변이지수여PiCC0혈류동역학지표구유상관성,가이위림상의사쾌속평고혈용량제공의거.
Objective To explore the correlation between radius and respiratory variation of inferior vena cava(IVC)and hemodynamic monitoring values of pulse-indicated continuous cardiac output(PiCCO)in septic shock pigs.Methods A total of 8 pigs were used to establish animal model of septic shock by intravenous infusing LPS(100 μg/kg),and fluid resuscitation was followed with normal saline.Ultrasound was used to measure the maximum radius(IVCmax)and minimum radius(IVCmin)of IVC,and respiration variation index(RVI)was calculated at basic status,septic shock,1 hour and 6 hours after fluid resuscitation,respectively.Respiratory variation index of IVC were calculated as:RVI =(IVCmax-IVCmin)/ IVCmax × 100％.Hemodynamic monitoring values,including ITBV,GEDV,SVV and CI of PiCCO,were recorded at the same time.Radius and RVI of IVC and PiCCO values between before and after fluid resuscitation were compared by LSD-t test.Correlation between radius and RVI of IVC andhemodynamic monitoring values were calculated by Pearson correlation coefficient.Results Compared with the moment of septic shock,IVC IVCmin,GEDV,ITBV and CI at 1 after hour fluid resuscitation were larger(P ＜ 0.01)and SVV and IVCrvi were smaller(P ＜ 0.01).Compared with the moment of septic shock and 1 after hour fluid resuscitation,IVC[VCmin,GEDV,[TBV and CI at 6 hours after fluid resuscitation were larger(P ＜ 0.01)and SVV and IVCrvi were smaller(P ＜ 0.01).IVCmax correlated with SVV(P=0.024)and it failed to correlate with GEDV,ITBV and CI.IVCmin correlated with GEDV(P=0.003),ITBV(P =0.001),SVV(P =0.009)and CI(P =0.015),respectively.RVI was correlated withGEDV(P＜0.01),ITBV(P＜0.01),SVV(P=0.007)and CI(P＜0.001),respectively.Conclusions Radius and RVI of IVC was correlated with hemodynamic monitoring values of PiCCO.It can serve as a parameter to rapidly estimate the blood volume.
