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[床边成像]

[Bedside imaging].

作者信息

Zilberszac Robert

机构信息

Universitätsklinik für Innere Medizin II, Abteilung für Kardiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.

出版信息

Med Klin Intensivmed Notfmed. 2024 Nov;119(8):624-628. doi: 10.1007/s00063-024-01191-3. Epub 2024 Oct 9.

DOI:10.1007/s00063-024-01191-3
PMID:39384618
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11538239/
Abstract

Sonography, in particular echocardiography, is essential in the assessment of volume status and hemodynamics in critically ill patients. Examination of the left ventricle, in addition to assessing ventricular function, provides valuable information, including the "kissing papillary muscle sign," which may indicate fluid responsiveness. Examination of the right ventricle is also important because it is sensitive to both volume and pressure overload. Assessment of diastolic function and measurement of inferior vena cava width and variability provide clues to left and right ventricular preload, respectively. Measurement of stroke volume and cardiac output allows further assessment of hemodynamics and also permits determination of stroke volume variability.

摘要

超声检查，尤其是超声心动图检查，对于评估危重症患者的容量状态和血流动力学至关重要。除了评估心室功能外，对左心室的检查还能提供有价值的信息，包括“亲吻乳头肌征”，这可能提示液体反应性。对右心室的检查也很重要，因为它对容量和压力超负荷均敏感。舒张功能评估以及下腔静脉宽度和变异性测量分别为左、右心室前负荷提供线索。每搏量和心输出量的测量有助于进一步评估血流动力学，还能确定每搏量变异性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f7/11538239/f71aeaf658c7/63_2024_1191_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f7/11538239/c17c669d42a0/63_2024_1191_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f7/11538239/04af770fadab/63_2024_1191_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f7/11538239/7c7278756ac3/63_2024_1191_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f7/11538239/f71aeaf658c7/63_2024_1191_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f7/11538239/c17c669d42a0/63_2024_1191_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f7/11538239/04af770fadab/63_2024_1191_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f7/11538239/7c7278756ac3/63_2024_1191_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f7/11538239/f71aeaf658c7/63_2024_1191_Fig4_HTML.jpg

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本文引用的文献

1
How can assessing hemodynamics help to assess volume status?评估血流动力学如何帮助评估血容量状态？
Intensive Care Med. 2022 Oct;48(10):1482-1494. doi: 10.1007/s00134-022-06808-9. Epub 2022 Aug 10.
2
A Test in Context: E/A and E/e' to Assess Diastolic Dysfunction and LV Filling Pressure.在语境中测试：E/A 和 E/e' 评估舒张功能障碍和左心室充盈压。
J Am Coll Cardiol. 2017 Mar 21;69(11):1451-1464. doi: 10.1016/j.jacc.2016.12.037.
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Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
超声心动图评估左心室舒张功能的建议：美国超声心动图学会和欧洲心血管影像学会的更新
Eur Heart J Cardiovasc Imaging. 2016 Dec;17(12):1321-1360. doi: 10.1093/ehjci/jew082. Epub 2016 Jul 15.
4
Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients?下腔静脉呼吸变异度能否预测自主呼吸患者的液体反应性？
Crit Care. 2015 Nov 13;19:400. doi: 10.1186/s13054-015-1100-9.
5
Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense.中心静脉压能否预测液体反应性？一项更新的荟萃分析及对一些常识的呼吁。
Crit Care Med. 2013 Jul;41(7):1774-81. doi: 10.1097/CCM.0b013e31828a25fd.
6
Haemodynamic monitoring using echocardiography in the critically ill: a review.超声心动图在危重病患者血流动力学监测中的应用：综述。
Cardiol Res Pract. 2012;2012:139537. doi: 10.1155/2012/139537. Epub 2012 Feb 14.
7
Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature.机械通气患者动脉波形衍生变量的动态变化与液体反应性：文献系统综述
Crit Care Med. 2009 Sep;37(9):2642-7. doi: 10.1097/CCM.0b013e3181a590da.
8
Demonstration of left ventricular outflow tract eccentricity by 64-slice multi-detector CT.64层多探测器CT对左心室流出道偏心度的显示
Int J Cardiovasc Imaging. 2009 Feb;25(2):175-81. doi: 10.1007/s10554-008-9362-9. Epub 2008 Sep 4.
9
Reappraisal of the use of inferior vena cava for estimating right atrial pressure.重新评估使用下腔静脉来估计右心房压力的方法。
J Am Soc Echocardiogr. 2007 Jul;20(7):857-61. doi: 10.1016/j.echo.2007.01.005.
10
Left atrial size: physiologic determinants and clinical applications.左心房大小：生理决定因素及临床应用
J Am Coll Cardiol. 2006 Jun 20;47(12):2357-63. doi: 10.1016/j.jacc.2006.02.048.