Çelebi Yamanoğlu Nalan Gökçe, Yamanoğlu Adnan, Parlak İsmet, Pınar Pelin, Tosun Ali, Erkuran Burak, Aydınok Gizem, Torlak Fatih
Beykoz State Hospital, Istanbul, Turkey.
Haseki Training and Research Hospital, Istanbul, Turkey.
Am J Emerg Med. 2015 Mar;33(3):433-8. doi: 10.1016/j.ajem.2014.12.014. Epub 2014 Dec 18.
This study aims to determine the site of and the best sonographic method for measurement of inferior vena cava (IVC) diameter in volume status monitoring.
This observational before-and-after study was performed at the intensive care unit of the emergency department. It included hypotensive adult patients with suspected sepsis who were recommended to receive at least 20 mg/kg fluid replacement by the emergency physician. The patients were fluid replaced at a rate of 1000 mL/h, and maximum and minimum IVC diameters were measured and the Caval index calculated sonographically via both B-mode and M-mode. Hence, IVC's volume response was assessed by a total of 6 parameters, 3 each in M-mode and B-mode. Freidman test was used to assess the change in IVC diameter with fluid replacement. Wilcoxon test with Bonferroni correction was used to determine which measurement method more sensitively measured IVC diameter change.
Twenty-eight patients with a mean age of 71.3 were included in the final analysis.The IVC diameter change was significant with all 6 methods (P < .001). The IVC minimum diameter change measured on M-mode during inspiration (M-mode i) was the only measurement method that significantly showed diameter change with each 500-mL fluid replacements. The initial and the subsequent M-mode i values after each 500 mL of fluid were 5.65 ± 3.34; 8.05 ± 3.66; 10.16 ± 3.61, and 11.21 ± 2.94, respectively (P < .001, P < .002, and P < .003, respectively).
Inferior vena cava diameter was changed by fluid administration. The M-mode i method that most sensitively measures that change may be the most successful method in volume status monitoring.
本研究旨在确定在容量状态监测中测量下腔静脉（IVC）直径的部位及最佳超声检查方法。
本前后对照观察性研究在急诊科重症监护病房进行。研究对象为疑似脓毒症的低血压成年患者，急诊医生建议这些患者至少接受20mg/kg的液体复苏。患者以1000mL/h的速度进行液体复苏，通过B超和M超测量IVC的最大和最小直径，并计算腔静脉指数。因此，通过总共6个参数评估IVC的容量反应，M超和B超各3个参数。采用Friedman检验评估液体复苏时IVC直径的变化。采用经Bonferroni校正的Wilcoxon检验确定哪种测量方法能更敏感地测量IVC直径变化。
最终分析纳入了28例平均年龄为71.3岁的患者。所有6种方法测得的IVC直径变化均具有显著性（P < .001）。吸气时M超测量的IVC最小直径变化（M超吸气时）是唯一一种能显著显示每500mL液体复苏后直径变化的测量方法。每次500mL液体复苏后最初及随后的M超吸气时测量值分别为5.65±3.34；8.05±3.66；10.16±3.61和11.21±2.94（分别为P < .001、P < .002和P < .003）。
液体输注可改变下腔静脉直径。在容量状态监测中，最能敏感测量这种变化的M超吸气时测量法可能是最成功的方法。
