Stone Michael B, Huang Jennifer V
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Glob Heart. 2013 Dec;8(4):323-7. doi: 10.1016/j.gheart.2013.11.004.
Bedside assessment of intravascular volume status plays an important role in the management of critically ill patients, guiding fluid replacement therapy and the use of vasopressor agents. Despite controversy in the existing evidence, many clinicians advocate the use of inferior vena cava ultrasound (IVC-US) in the assessment of intravascular volume status in critically ill patients. Respirophasic variation in IVC diameter may provide useful information regarding intravascular volume status, particularly in patients with high and low caval indices. However, due to conflicting results of small-scale clinical trials of divergent sample populations, there is insufficient evidence to support routine US assessment of the IVC to determine fluid responsiveness in spontaneous breathing with circulatory compromise. Additional large-scale clinical trials are required to determine the accuracy of IVC-US measurements in diverse populations and to ascertain the effects on IVC dimensions that result from cardiac dysfunction and intra-abdominal hypertension.
血管内容量状态的床边评估在危重症患者的管理中起着重要作用,指导液体替代治疗和血管升压药的使用。尽管现有证据存在争议,但许多临床医生主张使用下腔静脉超声(IVC-US)评估危重症患者的血管内容量状态。IVC直径的呼吸相变化可能提供有关血管内容量状态的有用信息,特别是在腔静脉指数高和低的患者中。然而,由于不同样本人群的小规模临床试验结果相互矛盾,没有足够的证据支持常规使用US评估IVC以确定有循环功能障碍的自主呼吸患者的液体反应性。需要更多大规模临床试验来确定不同人群中IVC-US测量的准确性,并确定心脏功能障碍和腹腔内高压对IVC尺寸的影响。