Zhao Jie, Wang Guolin
Department of Intensive Care Unit, Tianjin Medical University General Hospital, Tianjin, China (mainland).
Med Sci Monit. 2016 Oct 20;22:3843-3848. doi: 10.12659/msm.897406.
BACKGROUND This study aimed to investigate the relationship between the inferior vena cava respirophasic variation (IVC collapsibility index [IVCCI]) and the general heart end-diastolic volume index (GEDVI). By determining the above relationship, we could evaluate the utility of IVCCI as an indicator. MATERIAL AND METHODS Forty-two septic patients were finally enrolled in this study. The inferior vena cava's diameter was measured with the largest at the end of expiration (IVC3) and with the smallest at the end of inspiration (IVCi) on the ultrasound (IVCCI=[(IVCD e - IVCD i)/IVCD e] ×100%). The central venous pressure (CVP), cardiac index (CI), and GEDVI were also measured at least 3 times. After fluid resuscitation therapy, the patients with a CI increase induced by more than 15% and less than 15% were classified as the positive response group (PRG) and the negative response group (NRG), respectively. RESULTS After treatment, the average levels of CVP, CI, and GEDVI were significantly higher (P<0.01) in both groups, whereas the IVCCI was reduced. CVP, CI, and GEDVI were negatively correlated with IVCCI in both groups. The correlation coefficient between IVCCI and GEDVI was the greatest (correlation coefficient in the PRG group was 0.889 and in the NRG group it was 0.672). The ROC curve analysis indicated that IVCCI illustrated the best area under the curve, with a sensitivity of 100% and specificity of 100%, and a cut-off value of 12.9% to predict GEDVI <600 ml/m2 in the PRG group. CONCLUSIONS IVCCI was a good predictor of low-volume state. The IVCCI appears to be a valuable and non-invasive index for the estimation of elevated GEDVI during fluid resuscitation in septic shock patients.
背景 本研究旨在探讨下腔静脉呼吸相变异(IVC 塌陷指数[IVCCI])与总体心脏舒张末期容积指数(GEDVI)之间的关系。通过确定上述关系,我们可以评估 IVCCI 作为一种指标的效用。材料与方法 本研究最终纳入了 42 例脓毒症患者。在超声检查中,测量下腔静脉在呼气末的最大直径(IVC3)和吸气末的最小直径(IVCi)(IVCCI = [(IVCDe - IVCDi)/IVCDe]×100%)。还至少 3 次测量中心静脉压(CVP)、心脏指数(CI)和 GEDVI。液体复苏治疗后,CI 增加超过 15%和增加少于 15%的患者分别被归类为阳性反应组(PRG)和阴性反应组(NRG)。结果 治疗后,两组的 CVP、CI 和 GEDVI 的平均水平均显著升高(P<0.01),而 IVCCI 降低。两组中 CVP、CI 和 GEDVI 与 IVCCI 均呈负相关。IVCCI 与 GEDVI 之间的相关系数最大(PRG 组的相关系数为 0.889,NRG 组为 0.672)。ROC 曲线分析表明,IVCCI 的曲线下面积最佳,在 PRG 组中预测 GEDVI<600 ml/m²的敏感性为 100%,特异性为 100%,截断值为 12.9%。结论 IVCCI 是低血容量状态的良好预测指标。在脓毒症休克患者液体复苏期间,IVCCI 似乎是评估 GEDVI 升高的一种有价值的非侵入性指标。