Hung Kuo-Chuan, Huang Yen-Ta, Tsai Wen-Wen, Tan Ping-Heng, Wu Jheng-Yan, Huang Po-Yu, Liu Ting-Hui, Chen I-Wen, Sun Cheuk-Kwan
School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City 80424, Taiwan.
Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan.
Diagnostics (Basel). 2023 Jul 6;13(13):2290. doi: 10.3390/diagnostics13132290.
Despite the acceptance of carotid ultrasound for predicting patients' fluid responsiveness in critical care and anesthesia, its efficacy for predicting hypotension and fluid responsiveness remains unclear in the perioperative setting. Electronic databases were searched from inception to May 2023 to identify observational studies focusing on the use of corrected blood flow time (FTc) and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak) for assessing the risks of hypotension and fluid responsiveness. Using FTc as a predictive tool (four studies), the analysis yielded a pooled sensitivity of 0.82 (95% confidence interval (CI): 0.72 to 0.89) and specificity of 0.94 (95% CI: 0.88 to 0.97) for the risk of hypotension (area under curve (AUC): 0.95). For fluid responsiveness, the sensitivity and specificity of FTc were 0.79 (95% CI: 0.72 to 0.84) and 0.81 (95% CI: 0.75 to 0.86), respectively (AUC: 0.87). In contrast, the use of ΔVpeak to predict the risk of fluid responsiveness showed a pooled sensitivity of 0.76 (95% CI: 0.63 to 0.85) and specificity of 0.74 (95% CI: 0.66 to 0.8) (AUC: 0.79). The current meta-analysis provides robust evidence supporting the high diagnostic accuracy of FTc in predicting perioperative hypotension and fluid responsiveness, which requires further studies for verification.
尽管在重症监护和麻醉中，颈动脉超声已被认可用于预测患者的液体反应性，但其在围手术期预测低血压和液体反应性的效果仍不明确。检索了从数据库建立到2023年5月的电子数据库，以确定聚焦于使用校正血流时间（FTc）和颈动脉血流峰值速度的呼吸相变化（ΔVpeak）来评估低血压风险和液体反应性的观察性研究。将FTc用作预测工具（四项研究）时，分析得出预测低血压风险的合并敏感度为0.82（95%置信区间（CI）：0.72至0.89），特异度为0.94（95%CI：0.88至0.97）（曲线下面积（AUC）：0.95）。对于液体反应性，FTc的敏感度和特异度分别为0.79（95%CI：0.72至0.84）和0.81（95%CI：0.75至0.86）（AUC：0.87）。相比之下，使用ΔVpeak预测液体反应性风险的合并敏感度为0.76（95%CI：0.63至0.85），特异度为0.74（95%CI：0.66至0.8）（AUC：0.79）。当前的荟萃分析提供了有力证据，支持FTc在预测围手术期低血压和液体反应性方面具有较高的诊断准确性，这需要进一步研究加以验证。
