Department of Anesthesia and Critical Care, Ospedale SS Antonio e Biagio e Cesare Arrigo, via Venezia n 16, 15100, Alessandria, Italy.
Neurocrit Care. 2010 Aug;13(1):3-9. doi: 10.1007/s12028-010-9356-z.
The objective of our study is to assess the reliability of the distensibility of the inferior vena cava (dIVC), as measured by ultrasound, as an indicator of fluid responsiveness in patients with subarachnoid hemorrhage.
We enrolled 29 adult patients requiring advanced hemodynamic monitoring, sedation, and mechanical ventilation. Inferior vena cava diameter was measured during a single mechanical breath. The dIVC was calculated as (the diameter of the inferior vena cava on inspiration-the diameter on expiration)/the diameter on expiration. All the hemodynamic parameters were collected at baseline and after a fluid challenge (7 ml/kg) with 6% hydroxyethyl starch. A 15% increase of cardiac index was the standard criterion used to differentiate patients with and without a response to fluid therapy.
Apart from stroke volume variation (SVV) and dIVC, which were significantly higher in fluid responders (17 patients), the other baseline characteristics did not differ significantly between groups (responders versus non-responders). Significant changes in hemodynamic parameters after volume load were observed only in fluid responders. The area under the ROC curve was 0.779 (95% confidence interval 0.587-0.911) for SVV and 0.902 (95% confidence interval 0.733-0.979, P = NS) for dIVC. Central venous pressure was a less reliable indicator of fluid responsiveness than dIVC. A dIVC value of >16% yielded the most favorable balance of test characteristics, with 70.59% sensitivity and 100% specificity. There was a trend toward a lower incidence of delayed ischemic lesions in fluid responders (11.7 vs. 25%, P = NS).
dIVC proved to be a reliable predictor of fluid responsiveness in ICU patients with subarachnoid hemorrhage.
我们研究的目的是评估通过超声测量下腔静脉可扩张性（dIVC）作为蛛网膜下腔出血患者液体反应性的指标的可靠性。
我们纳入了 29 名需要进行高级血流动力学监测、镇静和机械通气的成年患者。在下腔静脉直径在单次机械呼吸期间进行测量。dIVC 计算为（吸气时下腔静脉直径-呼气时下腔静脉直径）/呼气时下腔静脉直径。所有血流动力学参数均在基线和 6%羟乙基淀粉 7ml/kg 液体冲击后收集。心指数增加 15%是区分液体治疗有反应和无反应患者的标准标准。
除了在液体反应者（17 名患者）中明显更高的每搏量变异（SVV）和 dIVC 外，两组间的其他基线特征没有显著差异（反应者与无反应者）。仅在液体反应者中观察到容量负荷后血流动力学参数的显著变化。SVV 的 ROC 曲线下面积为 0.779（95%置信区间 0.587-0.911），dIVC 的为 0.902（95%置信区间 0.733-0.979，P=NS）。中心静脉压是液体反应性的一个不太可靠的指标，比 dIVC 差。dIVC 值>16%可获得最佳的试验特征平衡，具有 70.59%的敏感性和 100%的特异性。液体反应者中迟发性缺血性病变的发生率呈下降趋势（11.7%对 25%，P=NS）。
dIVC 被证明是蛛网膜下腔出血 ICU 患者液体反应性的可靠预测指标。
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