Bou Chebl Ralphe, Abou Dagher Gilbert, Wuhantu Jeffrey, Bachir Rana, Carnell Jennifer
Department of Emergency Medicine, Ben Taub Hospital, Baylor College of Medicine, 1400 Taub Loop, Houston, TX, USA.
Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
Crit Ultrasound J. 2018 Dec 2;10(1):32. doi: 10.1186/s13089-018-0114-3.
Fluid responsiveness is an important topic for clinicians. Aggressive hydration has been shown to lead to worse outcomes. The aim of this study was to investigate the sensitivity and specificity of mitral valve (MV) velocity time integral (VTI) as a non-invasive marker of volume responsiveness.
This was a prospective observational study conducted in a tertiary emergency department. End-stage renal disease patients presenting to the emergency department requiring emergent hemodialysis were enrolled. A focused echocardiogram was done on enrolled patients. Two sets of measurements were obtained before and after hemodialysis. During each scanning session, the left ventricular outflow tract and the mitral valve VTI were obtained before and after a passive leg raise maneuver.
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. All patients had a diagnosis of hypertension, 22 (41%) patients were diabetic, 14 (26%) patients had coronary artery disease, and 19 (35%) patients had congestive heart failure. The mean change in LVOT VTI was 1.83% (95% CI 0.12-3.55) in the pre-dialysis group and 15.05% (95% CI 12.76-17.34) in the post-hemodialysis cohort. The mean change in MV VTI was 3.74% (95% CI 2.84-4.65) in the pre-dialysis cohort and 12.95% (95% CI 11.50-14.39) in the post-dialysis cohort. For patients who had < 4 L removed, the mean delta LVOT VTI post-hemodialysis was 12.64% (95% CI 9.79-15.49) and the mean delta MV VTI was 10.48% (95% CI 8.28-12.69). For patients who had > 4 L removed, the mean delta LVOT VTI was 16.84% (95% CI 13.47-20.22) and the mean MV VTI was 14.77% (95% CI 13.03-16.51). Mitral valve VTI with PLR was found to have a sensitivity of 89.18% and a specificity of 94.11% in detecting volume responsiveness.
Mitral valve velocity time integral in conjunction with passive leg raise seem to correlate with volume responsiveness in hemodialysis patients.
液体反应性是临床医生关注的重要课题。积极补液已被证明会导致更差的预后。本研究旨在探讨二尖瓣（MV）速度时间积分（VTI）作为容量反应性非侵入性标志物的敏感性和特异性。
这是一项在三级急诊科进行的前瞻性观察性研究。纳入因终末期肾病到急诊科就诊且需要紧急血液透析的患者。对纳入患者进行针对性超声心动图检查。在血液透析前后各进行两组测量。在每次扫描过程中，在被动抬腿动作前后获取左心室流出道和二尖瓣VTI。
共纳入54例患者，其中30例（55%）为男性。平均年龄为47.4岁。平均脱水量为3.89±0.91L。所有患者均诊断为高血压，22例（41%）患者患有糖尿病，14例（26%）患者患有冠状动脉疾病，19例（35%）患者患有充血性心力衰竭。透析前组左心室流出道VTI的平均变化为1.83%（95%CI 0.12 - 3.55），血液透析后队列中为15.05%（95%CI 12.76 - 17.34）。透析前队列中二尖瓣VTI的平均变化为3.74%（95%CI 2.84 - 4.65），透析后队列中为12.95%（95%CI 11.50 - 14.39）。对于脱水量<4L的患者，血液透析后左心室流出道VTI的平均变化量为12.64%（95%CI 9.79 - 15.49），二尖瓣VTI的平均变化量为10.48%（95%CI 8.28 - 12.69）。对于脱水量>4L的患者，左心室流出道VTI的平均变化量为16.84%（95%CI 13.47 - 20.22），二尖瓣VTI的平均变化量为14.77%（95%CI 13.03 - 16.51）。发现被动抬腿时二尖瓣VTI检测容量反应性的敏感性为89.18%，特异性为94.11%。
二尖瓣速度时间积分结合被动抬腿似乎与血液透析患者的容量反应性相关。
