超声下下腔静脉测量比生命体征异常更敏感，可用于识别中重度出血。
Ultrasonographic Inferior Vena Cava Measurement is More Sensitive Than Vital Sign Abnormalities for Identifying Moderate and Severe Hemorrhage.
机构信息
Department of Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York.
Department of Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
出版信息
J Emerg Med. 2022 Jan;62(1):64-71. doi: 10.1016/j.jemermed.2021.07.049. Epub 2021 Sep 17.
BACKGROUND
Ultrasound inferior vena cava (IVC) diameter has been shown to decrease in response to hemorrhage. IVC diameter cut points to identify moderate and severe blood loss have not been established.
OBJECTIVES
This study sought to find ultrasound IVC diameter cut points to identify moderate and severe hemorrhage and assess the performance of these cut points vs. vital sign abnormalities.
METHODS
This is a secondary analysis of data from a study that described changes in vital signs and sonographic measurements of the IVC during a lower body negative pressure model of hemorrhage. Using receiver operator curve analyses, optimal cut points for identifying moderate and severe hemorrhage were identified. The ability of these cut points to identify hemorrhage in patients with no vital sign abnormalities was then assessed.
RESULTS
In both long- and short-axis views, maximum and minimum IVC diameters (IVC and IVC) were significantly lower than baseline in severe blood loss. The optimal cut point for IVC in both axes was found to be ≤ 0.8 cm. This cut point is able to distinguish between no blood loss vs. moderate blood loss, and no blood loss vs. severe blood loss. The optimal cut point for IVC was variable between axes and blood loss severity. IVC diameter cut points obtained were able to identify hemorrhage in patients with no vital sign abnormalities.
CONCLUSION
An ultrasound IVC of ≤ 0.8 cm may be useful in identifying moderate and severe hemorrhage before vital sign abnormalities are evident.
背景
已经证明，超声下下腔静脉（IVC）直径会随着出血而减小。尚未确定用于识别中度和重度失血的 IVC 直径切点。
目的
本研究旨在寻找超声 IVC 直径切点，以识别中度和重度出血，并评估这些切点与生命体征异常的表现。
方法
这是一项对一项研究数据的二次分析，该研究描述了在下半身负压出血模型中生命体征和 IVC 超声测量的变化。使用接收器操作曲线分析，确定了识别中度和重度出血的最佳切点。然后评估这些切点在没有生命体征异常的患者中识别出血的能力。
结果
在长轴和短轴视图中，严重失血时 IVC 的最大和最小直径（IVC 和 IVC）均明显低于基线。在两个轴上 IVC 的最佳切点被发现为 ≤ 0.8 cm。该切点能够区分无失血与中度失血，以及无失血与重度失血。IVC 的最佳切点在轴之间和失血程度之间是可变的。获得的 IVC 直径切点能够识别无生命体征异常的患者中的出血。
结论
超声 IVC 直径 ≤ 0.8 cm 可能有助于在生命体征异常出现之前识别中度和重度出血。
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