Zhang Qing, Wang Xiaoting, Su Longxiang, Zhang Hongmin, Chai Wenzhao, Chao Yangong, He Wei, Liu Dawei
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Critical Care Medicine, Hua Xin Hospital, Tsinghua University, Beijing, China.
J Clin Ultrasound. 2018 Sep;46(7):450-454. doi: 10.1002/jcu.22586. Epub 2018 Mar 12.
To explore the relationship between the shape of the inferior vena cava (IVC) lumen and central venous pressure (CVP).
In 60 patients undergoing mechanical ventilation and CVP monitoring in the Intensive Care Unit of Peking Union Medical College Hospital from July to October 2016, we measured with B-mode ultrasonography the transverse maximum (MXD) and minimum diameter (MID) of the IVC at end expiration, and calculated the diameter ratio (DR) as MXD/MID. Patients were divided into three groups according to CVP: low (CVP < 8 mm Hg), intermediate (8 mm Hg ≤ CVP ≤ 10 mm Hg), and high (CVP > 10 mm Hg).
MXD was 2.32 ± 0.41 cm, MID was 1.41 ± 0.40 cm, and DR was 1.76 ± 0.49. CVP was 9.27 ± 2.99 mm Hg. DR correlated with CVP (r = -0.527, P < .001). The low-CVP group had greater dispersion of DR values, with a large variety in IVC shape (elliptical, irregular, teardrop-shaped, partially collapsed…). The area under the ROC curve for predicting CVP with DR, with a CVP threshold of 8 mm Hg was 0.835 (95% CI, 0.726-0.945; P < .05). With a DR cutoff value of 1.76, sensitivity was 0.765 and specificity was 0.781.
DR above 1.7 is predictive of CVP < 8 mm Hg.
探讨下腔静脉（IVC）管腔形态与中心静脉压（CVP）之间的关系。
2016年7月至10月，在北京协和医院重症监护病房对60例行机械通气及CVP监测的患者，采用B型超声测量呼气末IVC的横向最大直径（MXD）和最小直径（MID），并计算直径比（DR），即MXD/MID。根据CVP将患者分为三组：低CVP组（CVP＜8 mmHg）、中CVP组（8 mmHg≤CVP≤10 mmHg）和高CVP组（CVP＞10 mmHg）。
MXD为2.32±0.41 cm，MID为1.41±0.40 cm，DR为1.76±0.49。CVP为9.27±2.99 mmHg。DR与CVP相关（r = -0.527，P＜0.001）。低CVP组DR值的离散度更大，IVC形态多样（椭圆形、不规则形、泪滴形、部分塌陷……）。以DR预测CVP，CVP阈值为8 mmHg时，ROC曲线下面积为0.835（95%CI，0.726 - 0.945；P＜0.05）。DR临界值为1.76时，灵敏度为0.765，特异度为0.781。
DR大于1.7可预测CVP＜8 mmHg。
