下腔静脉大小与创伤后休克无关。
Inferior vena cava size is not associated with shock following injury.
机构信息
From the Section of Trauma and Acute Care Surgery (M.R., R.Ag., S.K., R.Am., J.M., J.D., B.S.), Department of Surgery, and Department of Radiology (D.S., N.K., K.B.), George Washington University, Washington, District of Columbia.
出版信息
J Trauma Acute Care Surg. 2014 Jul;77(1):34-9; discussion 39. doi: 10.1097/TA.0000000000000248.
BACKGROUND
The inferior vena cava (IVC) collapses with shock but may also be collapsed in volume-depleted patients in the absence of shock. The speed and availability of computed tomography (CT) make IVC measurement an attractive diagnostic modality for shock. The purpose of this study was to determine if IVC size following injury is associated with shock.
METHODS
Retrospective data were collected on 272 trauma patients admitted to an adult trauma center from January 1 to December 31, 2012. Patients who met the highest-level activation criteria and underwent an abdominal CT scan during their initial resuscitation were included. All images were reviewed by two attending radiologists, and concordance was assessed using the Pearson correlation coefficient. The transverse (T) and anteroposterior (AP) diameters of the IVC were measured to calculate a T/AP ratio. Analysis of variance and χ were used to assess for a relationship between this ratio and various indices of shock.
RESULTS
The mean (SD) age of the study cohort was 50 (21) years, mean (SD) Injury Severity Score (ISS) was 14 (9), 74% were male, and 96% sustained blunt trauma. The overall mean (SD) T/AP ratio was 1.81 (0.68). Patients with a shock index greater than 0.7 were significantly younger (43 [20] years vs. 55 [21] years, p < 0.0001), had a significantly lower mean arterial pressure (88 [15] mm Hg vs. 103 [18] mm Hg, p < 0.0001), and were more likely to be intubated (56% vs. 24%, p < 0.0001). However, IVC T/AP ratio was not significantly different among the cohort. Similarly, there was no association between IVC size and the need for urgent operation, angiography, emergent transfusion, hospital length of stay, or mortality.
CONCLUSION
The static degree of IVC collapse is not associated with shock following injury. Therefore, measurement of IVC size by CT scan for patients with a T/AP ratio between 1 and 3.5 is not clinically relevant and cannot be used to predict mortality, shock, or impending shock.
LEVEL OF EVIDENCE
Diagnostic test, level III.
背景
下腔静脉（IVC）在休克时会塌陷，但在没有休克的情况下，容量不足的患者的 IVC 也可能会塌陷。由于计算机断层扫描（CT）的速度和可用性，IVC 测量成为一种有吸引力的休克诊断方式。本研究的目的是确定损伤后 IVC 的大小是否与休克有关。
方法
回顾性收集了 2012 年 1 月 1 日至 12 月 31 日期间收入成人创伤中心的 272 例创伤患者的数据。符合最高级别的激活标准并在初始复苏期间接受腹部 CT 扫描的患者均被纳入研究。由两名主治放射科医生对所有图像进行复查，并使用 Pearson 相关系数评估一致性。测量 IVC 的横径（T）和前后径（AP），以计算 T/AP 比值。方差分析和卡方检验用于评估该比值与各种休克指数之间的关系。
结果
研究队列的平均（标准差）年龄为 50（21）岁，损伤严重程度评分（ISS）的平均（标准差）为 14（9）分，74%为男性，96%为钝器伤。总体平均（标准差）T/AP 比值为 1.81（0.68）。休克指数大于 0.7 的患者明显更年轻（43[20]岁 vs. 55[21]岁，p＜0.0001），平均动脉压明显更低（88[15]mmHg vs. 103[18]mmHg，p＜0.0001），更有可能进行气管插管（56% vs. 24%，p＜0.0001）。然而，队列中 IVC 的 T/AP 比值没有显著差异。同样，IVC 大小与紧急手术、血管造影、紧急输血、住院时间或死亡率之间也没有关联。
结论
损伤后 IVC 塌陷的程度与休克无关。因此，对于 T/AP 比值在 1 到 3.5 之间的患者，通过 CT 扫描测量 IVC 大小在临床上没有意义，不能用于预测死亡率、休克或即将发生的休克。
证据等级
诊断性试验，III 级。
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