Schriger D L, Baraff L J
Department of Medicine, UCLA School of Medicine.
Ann Emerg Med. 1991 Jun;20(6):601-5. doi: 10.1016/s0196-0644(05)82375-3.
To evaluate whether the capillary refill test can correctly differentiate between hypovolemic and euvolemic emergency department patients.
A prospective, nonrandomized, nonblinded time series.
The orthostatic and hypotensive patients were seen in a university hospital ED with 44,000 visits per year. Blood donors were studied in the hospital's blood donor center.
Thirty-two adult ED patients who presented with a history suggestive of hypovolemia and either abnormal orthostatic vital signs (19) or frank hypotension (13), and 47 volunteer blood donors who ranged in age from 19 to 83 participated.
Capillary refill was measured before rehydration in the ED subjects and, in the donor group, before and after a 450-mL blood donation.
Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. Analyses were stratified by age, sex, and study group.
For the blood donor group, mean capillary refill time before donation was 1.4 seconds and after donation was 1.1 seconds. Mean capillary refill time for the orthostatic group was 1.9 seconds and for the hypotensive group was 2.8 seconds. When scored with age-sex specific upper limits of normal, the sensitivity of capillary refill in identifying hypovolemic patients was 6% for the 450-mL blood loss group, 26% for the orthostatic group, and 46% for the hypotensive group. The accuracy of capillary refill in a patient with a 50% prior probability of hypovolemia is 64%. Orthostatic vital signs were found to be more sensitive and specific than capillary refill in detecting the 450-mL blood loss.
Capillary refill does not appear to be a useful test for detecting mild-to-moderate hypovolemia in adults.
评估毛细血管再充盈试验能否正确区分低血容量和血容量正常的急诊科患者。
一项前瞻性、非随机、非盲法的时间序列研究。
一所大学医院的急诊科，每年有44000人次就诊，体位性低血压和低血压患者在此就诊。在医院的献血中心对献血者进行研究。
32例成年急诊科患者，有提示低血容量的病史，且体位性生命体征异常（19例）或明显低血压（13例），以及47名年龄在19至83岁之间的志愿献血者参与研究。
在急诊科患者补液前测量毛细血管再充盈情况，在献血组，在450毫升献血前后测量。
计算敏感性、特异性、准确性以及阳性和阴性预测值。分析按年龄、性别和研究组进行分层。
对于献血组，献血前平均毛细血管再充盈时间为1.4秒，献血后为1.1秒。体位性低血压组平均毛细血管再充盈时间为1.9秒，低血压组为2.8秒。按照年龄和性别特异性正常上限进行评分时，对于450毫升失血量组，毛细血管再充盈识别低血容量患者的敏感性为6%，体位性低血压组为26%，低血压组为46%。在低血容量先验概率为50%的患者中，毛细血管再充盈的准确性为64%。发现在检测450毫升失血量时，体位性生命体征比毛细血管再充盈更敏感和特异。
毛细血管再充盈似乎不是检测成人轻至中度低血容量的有用试验。
