使用床边超声评估胃肠炎患儿脱水程度。
Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis.
机构信息
Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
出版信息
Acad Emerg Med. 2010 Oct;17(10):1042-7. doi: 10.1111/j.1553-2712.2010.00873.x.
OBJECTIVES
Prospectively identifying children with significant dehydration from gastroenteritis is difficult in acute care settings. Previous work by our group has shown that bedside ultrasound (US) measurement of the inferior vena cava (IVC) and the aorta (Ao) diameter ratio is correlated with intravascular volume. This study was designed to validate the use of this method in the prospective identification of children with dehydration by investigating whether the IVC/Ao ratio correlated with dehydration in children with acute gastroenteritis. Another objective was to investigate the interrater reliability of the IVC/Ao measurements.
METHODS
A prospective observational study was carried out in a pediatric emergency department (PED) between November 2007 and June 2009. Children with acute gastroenteritis were enrolled as subjects. A pair of investigators obtained transverse images of the IVC and Ao using bedside US. The ratio of IVC and Ao diameters (IVC/Ao) was calculated. Subjects were asked to return after resolution of symptoms. The difference between the convalescent weight and ill weight was used to calculate the degree of dehydration. Greater than or equal to 5% difference was judged to be significant. Linear regression was performed with dehydration as the dependent variable and the IVC/Ao as the independent variable. Pearson's correlation coefficient was calculated to assess the degree of agreement between observers.
RESULTS
A total of 112 subjects were enrolled. Seventy-one subjects (63%) completed follow-up. Twenty-eight subjects (39%) had significant dehydration. The linear regression model resulted in an R² value of 0.21 (p < 0.001) and a slope (B) of 0.11 (95% confidence interval [CI] = 0.08 to 0.14). An IVC/Ao cutoff of 0.8 produced a sensitivity of 86% and a specificity of 56% for the diagnosis of significant dehydration. Forty-eight paired measurements of IVC/Ao ratios were made. The Pearson correlation coefficient was 0.76.
CONCLUSIONS
In this pilot study the ratio of IVC to Ao diameters, as measured by bedside US, was a marginally accurate measurement of acute weight loss in children with dehydration from gastroenteritis. The technique demonstrated good interrater reliability.
目的
在急性护理环境中，前瞻性地识别患有肠胃炎的严重脱水儿童具有一定难度。我们小组之前的研究表明，下腔静脉（IVC）和主动脉（Ao）直径比的床边超声（US）测量与血管内容量相关。本研究旨在通过调查 IVC/Ao 比与急性肠胃炎患儿脱水之间的相关性，验证该方法在预测脱水儿童中的应用。另一个目的是研究 IVC/Ao 测量的组内信度。
方法
在 2007 年 11 月至 2009 年 6 月期间，在儿科急诊部（PED）进行了一项前瞻性观察研究。招募患有急性肠胃炎的儿童作为研究对象。一对研究人员使用床边 US 获得 IVC 和 Ao 的横断面图像。计算 IVC 和 Ao 直径比（IVC/Ao）。要求受试者在症状缓解后返回。用恢复体重和发病体重之间的差值来计算脱水程度。大于或等于 5%的差值被认为是显著的。以脱水为因变量，IVC/Ao 为自变量进行线性回归。计算观察者之间的一致性的 Pearson 相关系数。
结果
共纳入 112 例患儿，其中 71 例（63%）完成了随访。28 例（39%）患儿存在显著脱水。线性回归模型得出 R²值为 0.21（p < 0.001），斜率（B）为 0.11（95%置信区间[CI] = 0.08 至 0.14）。IVC/Ao 截断值为 0.8 时，对肠胃炎所致显著脱水的诊断，其灵敏度为 86%，特异性为 56%。对 48 对 IVC/Ao 比值进行了测量，Pearson 相关系数为 0.76。
结论
在本研究中，床边 US 测量的 IVC 与 Ao 直径比是肠胃炎所致脱水儿童急性体重下降的一种边缘准确的测量方法。该技术显示出良好的组内信度。
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