实验性急性呼吸窘迫综合征下腔静脉的扩张性指数
Distensibility index of the inferior vena cava in experimental acute respiratory distress syndrome.
作者信息
Mendes R, Oliveira M V, Padilha G A, Santos R S, Rocha N N, Luiz R R, Abreu M G, Pelosi P, Rocco P R M, Silva P L
机构信息
Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Brazil.
Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Brazil; Department of Physiology and Pharmacology, Biomedical Institute, Fluminense Federal University, Brazil.
出版信息
Respir Physiol Neurobiol. 2017 Mar;237:7-12. doi: 10.1016/j.resp.2016.12.011. Epub 2016 Dec 23.
We determined the accuracy of distensibility index of inferior vena cava (dIVC) for evaluation of fluid responsiveness in rats with acute respiratory distress syndrome (ARDS) and validated this index for use in rat models. In protocol 1, E. coli lipopolysaccharide was administered in Wistar rats (n=7). After 24h, animals were mechanically ventilated, and stroke volume (SV) and dIVC quantified after blood drainage and subsequent volume expansion (albumin 20%). A receiver operating characteristic (ROC) curve was plotted to determine the optimal dIVC cutoff. In protocol 2, rats (n=10) were divided into fluid-responders (SV increase >5%) and nonresponders (SV increase <5%). The dIVC cutoff obtained from protocol 1 was 25%. Fluid responders had a 2.5 relative risk of low dIVC (<25%). The sensitivity, specificity, positive predictive, and negative predictive values for dIVC were 74%, 62%, 59%, and 76%, respectively. In conclusion, a dIVC threshold <25% was associated with positive response after volume expansion and could be used to titrate fluids in endotoxin-induced ARDS.
我们测定了下腔静脉扩张指数（dIVC）在评估急性呼吸窘迫综合征（ARDS）大鼠液体反应性方面的准确性，并在大鼠模型中验证了该指数的应用。在方案1中，向Wistar大鼠（n = 7）注射大肠杆菌脂多糖。24小时后，对动物进行机械通气，在放血及随后的容量扩充（20%白蛋白）后量化每搏输出量（SV）和dIVC。绘制受试者工作特征（ROC）曲线以确定最佳dIVC临界值。在方案2中，将大鼠（n = 10）分为液体反应者（SV增加>5%）和无反应者（SV增加<5%）。从方案1获得的dIVC临界值为25%。液体反应者出现低dIVC（<25%）的相对风险为2.5。dIVC的敏感性、特异性、阳性预测值和阴性预测值分别为74%、62%、59%和76%。总之，dIVC阈值<25%与容量扩充后的阳性反应相关，可用于指导内毒素诱导的ARDS患者的液体输注。
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