Zhu Pin, Zhang Xiaobao, Luan Hengfei, Feng Jiying, Cui Jizheng, Wu Yong, Zhao Zhibin
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. 2015 Jun 1;196(1):102-6. doi: 10.1016/j.jss.2015.02.063. Epub 2015 Mar 5.
Previous studies have demonstrated that ultrasonographic measurement of the inferior vena cava diameter is a useful tool for the evaluation of intravascular volume status in preoperative patients. However, ultrasonographic measurement of inferior vena cava diameter could be limited by factors including obesity, bowel gas, or complex abdominal wounds. Our study sought to determine whether subclavian vein (SCV) diameter measured by ultrasound correlate with central venous pressure (CVP), as another indicator of intravascular volume status in patients undergoing gastrointestinal surgery.
Forty patients (American Society of Anesthesiologists I-II) who underwent elective gastrointestinal surgery and 40 healthy volunteers were enrolled in the study. In the patient group, SCV diameters, during both expiration (dSCVe) and inspiration (dSCVi), were measured with ultrasonography before and after fluid resuscitation. Volunteer baseline measurements were conducted without liquid therapy and the subsequent measurement.
Forty patients (mean age 46 y; 40% female) and 40 volunteers (mean age 43 y; 45% female) underwent SCV sonographic measurements. The average diameters of the SCVe and SCVi in hypovolemic patients (0.68, 0.48 cm) were significantly lower as compared with the SCVe and SCVi diameters of healthy volunteers (0.92, 0.73 cm), whereas the SCV-collapsibility index (0.35) was higher in the hypovolemic patients as compared with the healthy volunteers (0.20). After fluid resuscitation, the SCVe and SCVi diameters in hypovolemic patients (0.88, 0.67 cm) significantly increased, whereas the SCV-collapsibility index decreased (0.23). The pre-SCVe and the post-SCVe were closely correlated to the CVP (R = 0.612 and R = 0.547, respectively). Similarly, the pre-SCVi and the post-SCVi were correlated to the CVP (R = 0.452 and R = 0.507, respectively).
SCV diameter is consistently low in patients undergoing gastrointestinal surgery as compared with healthy subjects. Measuring the SCV diameter maybe an important addition to the ultrasonographic evaluation of hypovolemia and other potentially volume-depleted patients.
既往研究表明，超声测量下腔静脉直径是评估术前患者血管内容量状态的有用工具。然而，下腔静脉直径的超声测量可能受到肥胖、肠气或复杂腹部伤口等因素的限制。我们的研究旨在确定超声测量的锁骨下静脉（SCV）直径是否与中心静脉压（CVP）相关，CVP是胃肠道手术患者血管内容量状态的另一个指标。
40例接受择期胃肠道手术的患者（美国麻醉医师协会I-II级）和40名健康志愿者纳入本研究。在患者组中，在液体复苏前后，通过超声测量呼气期（dSCVe）和吸气期（dSCVi）的SCV直径。对志愿者进行基线测量时未进行液体治疗及后续测量。
40例患者（平均年龄46岁；40%为女性）和40名志愿者（平均年龄43岁；45%为女性）接受了SCV超声测量。与健康志愿者的SCVe和SCVi直径（0.92、0.73cm）相比，低血容量患者的SCVe和SCVi平均直径（0.68、0.48cm）显著更低，而低血容量患者的SCV塌陷指数（0.35）高于健康志愿者（0.20）。液体复苏后，低血容量患者的SCVe和SCVi直径（0.88、0.67cm）显著增加，而SCV塌陷指数降低（0.23）。SCVe前值和SCVe后值与CVP密切相关（分别为R = 0.612和R = 0.547）。同样，SCVi前值和SCVi后值与CVP相关（分别为R = 0.452和R = 0.507）。
与健康受试者相比，接受胃肠道手术的患者SCV直径始终较低。测量SCV直径可能是超声评估低血容量和其他潜在容量不足患者的重要补充。
