目的 探讨超声测量下腔静脉直径呼吸变异度(IVC-RVI)对老年髋部骨折患者术前容量反应性的预测价值,从而为临床补液提供指导.方法 采用回顾性病例对照研究分析2017年8月-2018年2月陆军军医大学大坪医院收治的39例老年髋部骨折患者临床资料,其中男15例,女24例;年龄65 ~92岁[(80.9±7.9)岁].于患者入手术间5min后以及容量负荷试验后5 min内分别记录心率(HR)、平均动脉压(MAP)、心输出量(CO)、每搏输出量(SV)等指标,同时超声测量下腔静脉呼气末最大直径(IVCe)和吸气末最小直径(IVCi),并计算下腔静脉直径呼吸变异度(IVC-RVI).21例患者SV增加量(△SV)≥15%为容量反应阳性组(阳性组),18例患者△SV< 15%为容量反应阴性组(阴性组).比较两组容量负荷试验前后HR、MAP、CO、SV、△SV、IVCe、IVCi、IVC-RVI等指标,分析各个参数与△SV的相关性,并用受试者工作特征(ROC)曲线及Pearson相关性分析评价IVC-RVI对老年髋部骨折患者术前容量反应性的预测价值.结果 容量负荷试验前,两组HR、MAP、CO、SV、IVCe差异均无统计学意义(P>0.05);阳性组IVCi显著小于阴性组,IVC-RVI显著大于阴性组(P均<0.05).容量负荷试验后,两组CO、IVCe、IVCi、IVC-RVI差异均无统计学意义(P>0.05);阳性组HR显著小于阴性组,MAP和SV显著大于阴性组(P<0.05).与容量负荷试验前比较,阳性组容量负荷试验后MAP、CO、SV均上升(P<0.05),HR差异无统计学意义(P>0.05);阴性组容量负荷试验后HR、MAP、CO、SV差异均无统计学意义(P>0.05).IVC-RVI评估老年髋部骨折患者术前容量反应性的曲线下面积(AUC)为0.80±0.08 (P <0.05),以20.69%为临界点,敏感度为77.78%,特异度为76.19%.经Pearson相关性分析,IVC-RVI与△SV呈正相关(r=0.367,P<0.05).结论 超声测量IVC-RVI能够预测老年髋部骨折患者术前容量反应性,IVC-RVI越大,容量反应性越佳,可为临床补液提供指导.
Objective To evaluate the predictive value of ultrasonography of the respiratory variability index of inferior vena cava internal diameter (IVC-RVI) in preoperative fluid responsiveness evaluation of hip fracture in geriatric patients.Methods A retrospective case-control study was used to analyze 39 cases of elderly hip fractures admitted to the Daping Hospital of Army Medical Center from August 2017 to February 2018,including 15 males and 24 females,aged 65-92 years [(80.9 ±7.9)years].The heart rate (HR),mean arterial pressure(MAP),cardiac output (CO),and cardiac stoke volume (SV)were recorded five minutes after the patient entered the operating room and within 5 minures after capacity load test.The inferior vena cave during expiration (IVCe) and inferior vena cave during inspiration (IVCi) were measured by ultrasound before and after volume load test and the difference in IVC-RVI was calculated.Volumetric positive group were the cases of SV change (△SV) ≥15% (positive group,n =21),and volume negative group were the cases of △SV < 15% (negative group,n=18).The correlations between various ultrasonic parameters and SV were analyzed by comparing HR,MAP,CO,SV,SV,IVCe,IVCi and IVC-RVI before and after the capacity load test.The predictive value of IVC-RVI for preoperative volumetric reactivity in elderly patients with hip fractures was evaluated by using the receiver operative characteristic (ROC) curve and Pearson correlation analysis.Results Prior to the volumetric load test,no significant difference was observed between the two groups concerning HR,MAP,CO,SV,and IVCe (P > 0.05),IVCi in the positive group was significantly smaller than that in the negative group (P < 0.05),and IVC-RVI in the positive group was significantly larger than that in the negative group (P < 0.05).After the volumetric load test,there was no statistically significant difference between the two groups in CO,IVCe,IVCi,and IVC-RVI (P > 0.05),HR in the positive group was smaller than that in the negative group (P < 0.05),and MAP and SV in the positive group were significantly larger than that in the negative group (P < 0.05).Compared with that before capacity load test,MAP,CO,and SV in the positive group increased after the capacity load test (P < 0.05),while the HR difference was not statistically significant (P > 0.05).HR,MAP,CO,and SV showed no significant difference in the negative group before and after capacity test (P > 0.05).IVC-RVI assessed the area under the curve (AUC) was 0.80 ± 0.08 for preoperative volumetric responsiveness in elderly hip fractures (P < 0.05),with a critical point of 20.69%,sensitivity of 77.78%,and specificity of 76.19%.After Pearson correlation analysis,IVC-RVI was positively related to △SV (OR =0.367,P < 0.05).Conclusion Ultrasonography of the respiratory variability of IVC can predict the preoperative fluid responsiveness of hip fracture in geriatric patients and guide for clinical rehydration.