Department of Anesthesiology, The First People's Hospital of Lianyungang City, Lianyungang, China.
Department of Anesthesiology, The First People's Hospital of Lianyungang City, Lianyungang, China.
J Surg Res. 2014 Oct;191(2):339-43. doi: 10.1016/j.jss.2014.04.043. Epub 2014 May 1.
Ultrasonography has been suggested as a useful noninvasive tool for the detection of hypovolemia in critically ill patients. Hypovolemia after preoperative fasting and bowel preparation may compromise hemodynamic function during gastrointestinal surgery. However, there are few data comparing ultrasonographic examination of the inferior vena cava (IVC) diameter with central venous pressure (CVP) measurement in patients undergoing gastrointestinal surgery in the assessment of intravascular volume status.
Forty American Society of Anesthesiologists I-II patients who underwent elective gastrointestinal surgery and 32 healthy volunteers were enrolled in the study. The IVC diameters, both during expiration (IVCe) and inspiration (IVCi), and right ventricle (RV) were measured with ultrasonography in patients both before and after fluid resuscitation. Volunteers were also measured during the time they participated in the study.
Forty patients (mean age 51 y; 45% female) and 32 volunteers (mean age 46 y; 44% female) underwent IVC and RV sonographic measurements. The diameters of the IVCe, IVCi, and RV in patients (1.83, 1.34, and 3.23 cm) were significantly lower compared with those of healthy volunteers (1.18, 0.62, and 2.71 cm). After fluid resuscitation, IVCe, IVCi, and RV in hypovolemic patients (1.75, 1.25, and 3.27 cm) significantly increased. The pre-IVCe and the post-IVCe were closely correlated to the CVP (r = 0.585 and r = 0.609, respectively). Similarly, the pre-RV and the post-RV were correlated to the CVP (r = 0.347 and r = 0.439, respectively).
Our data demonstrate that the IVC and RV diameters are consistently low in patients undergoing gastrointestinal surgery when compared with healthy subjects. Ultrasonographic measurements of the IVC and RV diameters are useful supplement of CVP for the evaluation of preoperative patients with hypovolemia.
超声检查已被认为是一种有用的非侵入性工具，可用于检测危重病患者的低血容量。术前禁食和肠道准备后发生的低血容量可能会影响胃肠道手术期间的血流动力学功能。然而，在评估血管内容量状态方面，比较胃肠道手术患者下腔静脉（IVC）直径的超声检查与中心静脉压（CVP）测量的数据很少。
本研究纳入了 40 名接受择期胃肠道手术的美国麻醉医师协会 I-II 级患者和 32 名健康志愿者。在液体复苏前后，使用超声测量患者的 IVC 直径（呼气时 IVCe 和吸气时 IVCi）和右心室（RV）。志愿者在参与研究期间也进行了测量。
40 名患者（平均年龄 51 岁；45%为女性）和 32 名志愿者（平均年龄 46 岁；44%为女性）接受了 IVC 和 RV 超声测量。患者的 IVCe、IVCi 和 RV 直径（1.83、1.34 和 3.23cm）明显低于健康志愿者（1.18、0.62 和 2.71cm）。在液体复苏后，低血容量患者的 IVCe、IVCi 和 RV 直径（1.75、1.25 和 3.27cm）显著增加。预 IVCe 和后 IVCe 与 CVP 密切相关（r = 0.585 和 r = 0.609）。同样，预 RV 和后 RV 与 CVP 相关（r = 0.347 和 r = 0.439）。
我们的数据表明，与健康受试者相比，接受胃肠道手术的患者 IVC 和 RV 直径始终较低。IVC 和 RV 直径的超声测量是 CVP 的有用补充，可用于评估术前低血容量患者。
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