床旁超声监测颈总动脉峰流速随正压通气的周期性变异率评估外科ICU病人容量状态的可行性

陈耀武; 陈一峰; 毛和明; 和耀武; 杨洪梅; 吴忠艳; 周朝勇

doi:10.13898/j.cnki.issn.1000-2200.2021.01.019

床旁超声监测颈总动脉峰流速随正压通气的周期性变异率评估外科ICU病人容量状态的可行性

Feasibility of bedside ultrasound monitoring the periodic variation rate of peak velocity of common carotid artery with positive pressure ventilation in the evaluation of the volume status of surgical ICU patients

摘要

摘要:
目的探讨床旁超声监测颈总动脉峰流速随正压通气的周期性变异率(ΔVpeak-CCA)用于评估外科ICU病人容量状态的效果及可行性。
方法随机抽取实施机械通气治疗的外科ICU病人50例为观察对象，对所有病人实施容量负荷试验，根据评估容量反应性金标准每搏量增加值(ΔSV)分为反应组28例(补液扩容有反应，ΔSV≥15%)和无反应组22例(补液扩容无反应，ΔSV < 15%)。对所有病人实施床旁超声监测，比较2组病人ΔVpeak-CCA，并分析ΔVpeak-CCA与ΔSV的相关性。
结果2组病人扩容前后每搏输出量差异均无统计学意义(P>0.05)；反应组病人ΔSV、ΔVpeak-CCA均明显高于无反应组(P < 0.01)，一个呼吸周期内颈总动脉峰流速的最大值、最小值均低于无反应组(P < 0.05)。外科ICU病人ΔSV与ΔVpeak-CCA呈正相关关系(r=0.862，P < 0.05)。ΔVpeak-CCA的ROC曲线下面积为0.846，ΔVpeak-CCA的诊断阈值为12.36%，敏感度为93.48%，特异度为81.09%。
结论床旁超声监测ΔVpeak-CCA应用于外科ICU病人容量状态评估具有较好的准确性，可为临床准确分析病人病情提供依据，值得推广。

Abstract:
ObjectiveTo investigate the effects and feasibility of bedside ultrasound monitoring the periodic variation rate of peak velocity of common carotid artery with positive pressure ventilation in evaluating the volume status of surgical ICU patients.
MethodsThe capacity load in 50 surgical ICU patients treated with mechanical ventilation was tested.According to the added value of stroke volume(ΔSV)of the gold standard for assessing volumetric reactivity, the patients were divided into the reaction group(28 cases, rehydration capacity, ΔSV ≥15%)and non-reaction group(22 cases, rehydration capacity without reaction, ΔSV < 15%).All patients were monitored using bedside ultrasound, the periodic variation rate of peak velocity of common carotid artery(ΔVpeak-CCA)was compared between two groups, and the correlation between ΔVpeak-CCA and ΔSV was analyzed.
ResultsThere was no statistical significance in SV between two groups before and after the expansion(P>0.05), the ΔSV and ΔVpeak-CCA in reaction group were significantly higher than those in non-reaction group(P < 0.05), and the Vpeak-max and Vpeak-min in reaction group were lower than those in non-reaction group(P < 0.05).The ΔSV of surgical ICU patients was positively correlated with the ΔVpeak-CCA(r=0.862, P < 0.05).The area under the ΔVpeak-CCA ROC curve was 0.846, the diagnostic threshold of ΔVpeak-CCA was 12.36%, the sensitivity was 93.48%, and the specificity was 81.09%.
ConclusionsThe bedside ultrasound monitoring the periodic variation rate of peak velocity of common carotid artery with positive pressure ventilation in evaluating the volume status of surgical ICU patients is effective and feasible.It can provide a basis for physicians to analyze the patients' condition, and is worthy of popularization.

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