中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2013年
11期
1252-1255
,共4页
陶永康%张国强%王海峰%刘笑雷%齐志伟%闫圣涛%陆海涛%顾承东
陶永康%張國彊%王海峰%劉笑雷%齊誌偉%閆聖濤%陸海濤%顧承東
도영강%장국강%왕해봉%류소뢰%제지위%염골도%륙해도%고승동
超声检查%脓毒症休克%中心静脉压%液体复苏
超聲檢查%膿毒癥休剋%中心靜脈壓%液體複囌
초성검사%농독증휴극%중심정맥압%액체복소
Ultrasonography%Septic shock%Central venous pressure%Fluid resuscitation
目的 研究床旁超声检测仪测量下腔静脉管径并计算呼吸变异指数,评估其与脓毒症休克动物模型/患者血容量的相关性.方法 选取8只幼年猪,使用大肠杆菌内毒素制作脓毒症休克模型,分别在建模前、建模成功时、建模成功后1h及6h时使用便携式超声检查仪测量肝后下腔静脉最大径(IVCmax),下腔静脉最小径(IVCmin),并计算下腔静脉呼吸变异指数(IVC.i),同时记录中心静脉压(CVP);另外,使用便携式超声检查仪对急诊重症监护病房28例脓毒症休克患者分别于液体复苏前、液体复苏2h及6h时测量肝后下腔静脉管径(IVCmax、IVCmin)并计算IVCrvi,同时记录CVP,分析IVCmax、IVCmin及IVCrvi与CVP的相关性,并进一步分别计算IVCmax、IVCmin及IVCrvi与CVP的回归方程.结果 脓毒症休克猪模型建模成功时,IVCmax、IVCmin、IVCrvi分别为(0.90 ±0.17) cm、(0.35±0.11) cm、(59.26±17.81)％;液体复苏6h后,IVCmax、IVCmin 明显增加分别为(1.04±0.15) cm、(0.79 ±0.08) cm,而IVCrvi明显减少为(23.66±5.52)％(均P＜0.01),IVC max、IVCmin与CVP呈正相关(r=0.443、0.616,均P＜0.01);IVCrvi与CVP呈负相关(r=-0.720,P＜0.01).脓毒症休克患者复苏前IVCmax、IVCmin、IVCrvi分别为(1.23±0.28) cm、(0.48 ±0.18) cm、(55.88±11.18)％;液体复苏6h后IVCmax、IVCmin明显增加分别为(1.71 ±0.41) cm、(1.34±0.45) cm,而IVCrvi明显减少为(24.19±13.61)％(均P＜0.01),IVC max、IVCmin与CVP呈正相关(r=0.668、0.863,均P＜0.01),IVCrvi与CVP呈负相关(r=-0.848,P＜0.01),进一步进行线性回归分析,得出回归方程:CVP=4.75×IVCmax-0.48 (F=61.08,P＜0.01); CVP=4.87 ×IVCmin +1.95 (F=222.2,P＜0.01); CVP=-12.66×IVCrvi+11.35(F=194.54,P＜0.01).结论 超声测量下腔静脉管径参数能反映脓毒症休克猪模型与脓毒症休克患者的CVP水平,可在一定程度上指导脓毒症休克的液体复苏治疗.
目的 研究床徬超聲檢測儀測量下腔靜脈管徑併計算呼吸變異指數,評估其與膿毒癥休剋動物模型/患者血容量的相關性.方法 選取8隻幼年豬,使用大腸桿菌內毒素製作膿毒癥休剋模型,分彆在建模前、建模成功時、建模成功後1h及6h時使用便攜式超聲檢查儀測量肝後下腔靜脈最大徑(IVCmax),下腔靜脈最小徑(IVCmin),併計算下腔靜脈呼吸變異指數(IVC.i),同時記錄中心靜脈壓(CVP);另外,使用便攜式超聲檢查儀對急診重癥鑑護病房28例膿毒癥休剋患者分彆于液體複囌前、液體複囌2h及6h時測量肝後下腔靜脈管徑(IVCmax、IVCmin)併計算IVCrvi,同時記錄CVP,分析IVCmax、IVCmin及IVCrvi與CVP的相關性,併進一步分彆計算IVCmax、IVCmin及IVCrvi與CVP的迴歸方程.結果 膿毒癥休剋豬模型建模成功時,IVCmax、IVCmin、IVCrvi分彆為(0.90 ±0.17) cm、(0.35±0.11) cm、(59.26±17.81)％;液體複囌6h後,IVCmax、IVCmin 明顯增加分彆為(1.04±0.15) cm、(0.79 ±0.08) cm,而IVCrvi明顯減少為(23.66±5.52)％(均P＜0.01),IVC max、IVCmin與CVP呈正相關(r=0.443、0.616,均P＜0.01);IVCrvi與CVP呈負相關(r=-0.720,P＜0.01).膿毒癥休剋患者複囌前IVCmax、IVCmin、IVCrvi分彆為(1.23±0.28) cm、(0.48 ±0.18) cm、(55.88±11.18)％;液體複囌6h後IVCmax、IVCmin明顯增加分彆為(1.71 ±0.41) cm、(1.34±0.45) cm,而IVCrvi明顯減少為(24.19±13.61)％(均P＜0.01),IVC max、IVCmin與CVP呈正相關(r=0.668、0.863,均P＜0.01),IVCrvi與CVP呈負相關(r=-0.848,P＜0.01),進一步進行線性迴歸分析,得齣迴歸方程:CVP=4.75×IVCmax-0.48 (F=61.08,P＜0.01); CVP=4.87 ×IVCmin +1.95 (F=222.2,P＜0.01); CVP=-12.66×IVCrvi+11.35(F=194.54,P＜0.01).結論 超聲測量下腔靜脈管徑參數能反映膿毒癥休剋豬模型與膿毒癥休剋患者的CVP水平,可在一定程度上指導膿毒癥休剋的液體複囌治療.
목적 연구상방초성검측의측량하강정맥관경병계산호흡변이지수,평고기여농독증휴극동물모형/환자혈용량적상관성.방법 선취8지유년저,사용대장간균내독소제작농독증휴극모형,분별재건모전、건모성공시、건모성공후1h급6h시사용편휴식초성검사의측량간후하강정맥최대경(IVCmax),하강정맥최소경(IVCmin),병계산하강정맥호흡변이지수(IVC.i),동시기록중심정맥압(CVP);령외,사용편휴식초성검사의대급진중증감호병방28례농독증휴극환자분별우액체복소전、액체복소2h급6h시측량간후하강정맥관경(IVCmax、IVCmin)병계산IVCrvi,동시기록CVP,분석IVCmax、IVCmin급IVCrvi여CVP적상관성,병진일보분별계산IVCmax、IVCmin급IVCrvi여CVP적회귀방정.결과 농독증휴극저모형건모성공시,IVCmax、IVCmin、IVCrvi분별위(0.90 ±0.17) cm、(0.35±0.11) cm、(59.26±17.81)％;액체복소6h후,IVCmax、IVCmin 명현증가분별위(1.04±0.15) cm、(0.79 ±0.08) cm,이IVCrvi명현감소위(23.66±5.52)％(균P＜0.01),IVC max、IVCmin여CVP정정상관(r=0.443、0.616,균P＜0.01);IVCrvi여CVP정부상관(r=-0.720,P＜0.01).농독증휴극환자복소전IVCmax、IVCmin、IVCrvi분별위(1.23±0.28) cm、(0.48 ±0.18) cm、(55.88±11.18)％;액체복소6h후IVCmax、IVCmin명현증가분별위(1.71 ±0.41) cm、(1.34±0.45) cm,이IVCrvi명현감소위(24.19±13.61)％(균P＜0.01),IVC max、IVCmin여CVP정정상관(r=0.668、0.863,균P＜0.01),IVCrvi여CVP정부상관(r=-0.848,P＜0.01),진일보진행선성회귀분석,득출회귀방정:CVP=4.75×IVCmax-0.48 (F=61.08,P＜0.01); CVP=4.87 ×IVCmin +1.95 (F=222.2,P＜0.01); CVP=-12.66×IVCrvi+11.35(F=194.54,P＜0.01).결론 초성측량하강정맥관경삼수능반영농독증휴극저모형여농독증휴극환자적CVP수평,가재일정정도상지도농독증휴극적액체복소치료.
Objective To explore the relationship between caliber of internal diameter of inferior vena cava (IVC) or respiratory variation and central vein pressure (CVP) in septic shock swine/patients.Methods A total of 8 swine were infused with LPS (100 μg/kg) intravenously to establish animal model of septic shock,and fluid resuscitation was followed with normal saline.Ultrasound was used to measure the maximum internal diameter (IVCmax) and minimum internal diameter (IVCmin) of IVC,and respiration variation index (IVCrvi) was calculated at normal status,septic shock,1 hour and 6 hours after fluid resuscitation,respectively.CVP was recorded at the same time.On the other hand,28 septic shock patients were recruited,IVCmax,IVCmin and CVP were recorded before and at 2 h and 6 h during fluid resuscitation.IVCrvi were calculated as IVCrvi =(IVCmax-IVCmin) / IVCmax × 100％,Correlation of IVCmax,IVCmin and IVCrvi with CVP were analyzed and linear regression equations were caculated.Results In septic shock swine,comparison of IVC calibers between pre-modeling and post-modeling demostrated the value of IVCmax (0.90±0.17) cm vs.(1.04 ±0.15) cm,P＜0.01,IVCmin (0.35 ±0.11) cm vs.(0.79 ±0.08)cm,P ＜0.01,IVCrvi (59.26 ± 17.81)％ vs.(23.66 ±5.52)％,P ＜0.01,and changed significatantly 6 h later.IVCmax and IVCmin were positively (r =0.443 and 0.616,both P ＜ 0.01) and IVCrvi negatively (r =-0.720,P ＜ 0.01) correlated with CVP.In septic shock patients,comparison of IVC calibers before and after fluid resuscitation for 6 hours showed the value of IVCmax (1.23 ±0.28) cm vs.(1.71 ±0.41)cm,P＜0.01,IVCmin (0.48 ±0.18) cm vs.(1.34±0.45) cm,P＜0.01,IVCrvi (55.88 ±11.18)％ vs.(24.19 ± 13.61)％,P ＜0.01.IVCmax and IVCmin were positively (r =0.668 arnd 0.863,both P ＜ 0.01) and IVCrvi negatively (r =0.848,P ＜ 0.01) correlated with CVP.Regression equations of septic patients indicated CVP =4.75 × IVCmax-0.48 (F =61.08,P ＜ 0.01),CVP =4.87 × IVCmin +1.95 (F =222.2,P ＜ 0.01),CVP =-12.66 × IVCrvi + 11.35 (F =194.54,P ＜ 0.001).Conclusions Internal diameter of IVC is found to be correlated with CVP which reflects cardiac preload.Using ultrasound to detect IVC may be useful in the fluid resuscitation of septic shock.
