Zhang Qian, Shi Xiu-Rong, Shan Yi, Wan Jian, Ju Xuan, Song Xi, Fan Conghui, Lu Xinyuan, Sun Jie, Duan Liwei, Lin Zhaofen, Liu Jinlong
Department of Emergency and Critical Care Medicine, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland).
Department of Ultrasonography, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland).
Med Sci Monit. 2021 Jan 8;27:e928804. doi: 10.12659/MSM.928804.
BACKGROUND This study aimed to assess the correlation between the variability of the end-inspiratory and end-expiratory blood flow waveform and fluid responsiveness (FR) in traumatic shock patients who underwent mechanical ventilation by evaluating peripheral arterial blood flow parameters. MATERIAL AND METHODS A cohort of 60 patients with traumatic shock requiring mechanical ventilation-controlled breathing received ultrasound examinations to assess the velocity of carotid artery (CA), femoral artery (FA) and brachial artery (BA). A rehydration test was performed in which of 250 mL of 0.9% saline was administered within 30 min between the first and second measurement of cardiac output by echocardiography. Then, all patients were divided into 2 groups, a responsive group (FR+) and a non-responsive group (FR-). The velocity of end-inspiratory and end-expiratory peripheral arterial blood flow of all patients was ultrasonically measured, and the variability were measured between end-inspiratory and end-expiratory. RESULTS The changes in the end-inspiratory and end-expiratory carotid artery blood flow velocity waveforms of the FR+ groups were significantly different from those of the FR- group (P<0.001). A statistically significant difference in ΔVmax (CA), ΔVmax (BA), and ΔVmax (FA) between these 2 groups was found (all P<0.001). The ROC curve showed that DVmax (CA) and ΔVmax (BA) were more sensitive values to predict FR compared to ΔVmax (FA). The sensitivity of ΔVmax (CA), ΔVmax (FA), and ΔVmax (BA) was 70.0%, 86.7%, and 93.3%, respectively. CONCLUSIONS The study showed that periodic velocity waveform changes in the end-inspiratory and end-expiratory peripheral arterial blood flow can be used for quick assessment of fluid responsiveness.
背景 本研究旨在通过评估外周动脉血流参数，来评估接受机械通气的创伤性休克患者吸气末和呼气末血流波形的变异性与液体反应性（FR）之间的相关性。
材料与方法 对60例需要机械通气控制呼吸的创伤性休克患者进行队列研究，接受超声检查以评估颈动脉（CA）、股动脉（FA）和肱动脉（BA）的血流速度。进行补液试验，即在通过超声心动图首次和第二次测量心输出量之间的30分钟内给予250 mL 0.9%生理盐水。然后，将所有患者分为两组，反应组（FR+）和无反应组（FR-）。超声测量所有患者吸气末和呼气末外周动脉血流速度，并测量吸气末和呼气末之间的变异性。
结果 FR+组吸气末和呼气末颈动脉血流速度波形的变化与FR-组有显著差异（P<0.001）。发现这两组之间的ΔVmax（CA）、ΔVmax（BA）和ΔVmax（FA）有统计学显著差异（均P<0.001）。ROC曲线显示，与ΔVmax（FA）相比，DVmax（CA）和ΔVmax（BA）是预测FR更敏感的值。ΔVmax（CA）、ΔVmax（FA）和ΔVmax（BA）的敏感性分别为70.0%、86.7%和93.3%。
结论 该研究表明，吸气末和呼气末外周动脉血流的周期性速度波形变化可用于快速评估液体反应性。
