校正颈动脉血流时间和被动抬腿作为容量状态的测量指标。
Corrected carotid flow time and passive leg raise as a measure of volume status.
机构信息
Department of Emergency Medicine, Ben Taub Hospital, Baylor College of Medicine, Houston, TX, United States of America; Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
Department of Emergency Medicine, Ben Taub Hospital, Baylor College of Medicine, Houston, TX, United States of America.
出版信息
Am J Emerg Med. 2019 Aug;37(8):1460-1465. doi: 10.1016/j.ajem.2018.10.047. Epub 2018 Oct 23.
BACKGROUND
The aim of this study was to investigate the value of corrected carotid flow time (FTc) with passive leg raise (PLR) as a non-invasive marker of volume status in end stage renal disease (ESRD) patients.
METHODS
Prospective observational study of ESRD patients presenting to the Emergency department requiring hemodialysis. The common carotid artery was evaluated in long axis. Flow time measurements pre- and post-dialysis as well as before and after PLR were recorded.
RESULTS
54 patients were enrolled, of which, 30 (55%) were male. The mean age was 47.4 years. The mean volume of fluid removed was 3.89 ± 0.91 L. In the pre-dialysis cohort, the mean FTc was 340.16 ms (95% CI, 330.36-349.95). Following PLR, the mean FTc was 341.34 ms (95% CI 331.74-350.94). In the post hemodialysis cohort, the mean FTc was 302.48 ms (95% CI, 293.63-311.32). Following the PLR maneuver, the mean FTc was 340.49 ms (95% CI 331.97-349.02). The mean decrease in corrected carotid flow time was 19.15 ms (95% CI, 22.86-41.17), 32.02 ms (95% CI 4.05-34.25) and 41.17 ms (95% CI, 36.47-54.76) for patients who had <3 L, 3-4 L and >4 L removed, respectively. In patients without CHF, the mean decrease in FTc after hemodialysis was 38.80 ms (95% CI, 30.12-47.49) whereas for CHF patients the mean decrease was 35.60 ms (95% CI, 25.05-46.15).
CONCLUSION
Corrected flow time in conjunction with passive leg raise seem to correlate with volume status in hemodialysis patients.
背景
本研究旨在探讨被动抬腿（PLR）校正颈动脉血流时间（FTc）作为终末期肾病（ESRD）患者容量状态的非侵入性标志物的价值。
方法
对因需要血液透析而到急诊就诊的 ESRD 患者进行前瞻性观察性研究。在长轴方向评估颈总动脉。记录透析前后以及 PLR 前后的血流时间测量值。
结果
共纳入 54 例患者，其中 30 例（55%）为男性。平均年龄为 47.4 岁。平均去除的液体量为 3.89±0.91 L。在透析前队列中，FTc 的平均值为 340.16 ms（95%CI，330.36-349.95）。PLR 后，FTc 的平均值为 341.34 ms（95%CI 331.74-350.94）。在血液透析后队列中，FTc 的平均值为 302.48 ms（95%CI，293.63-311.32）。PLR 操作后，FTc 的平均值为 340.49 ms（95%CI 331.97-349.02）。校正颈动脉血流时间的平均下降值分别为<3 L、3-4 L 和>4 L 时为 19.15 ms（95%CI，22.86-41.17）、32.02 ms（95%CI，4.05-34.25）和 41.17 ms（95%CI，36.47-54.76）。在没有充血性心力衰竭（CHF）的患者中，血液透析后 FTc 的平均下降值为 38.80 ms（95%CI，30.12-47.49），而 CHF 患者的平均下降值为 35.60 ms（95%CI，25.05-46.15）。
结论
校正后的血流时间与被动抬腿相结合似乎与血液透析患者的容量状态相关。
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