目的:探究心脏超声结合下腔静脉内径呼吸变异度预测重症监护室(ICU)脓毒症患者容量反应性的临床价值.方法:将 2021 年 1 月~2023 年 5 月于我院接受治疗的 60例ICU脓毒症患者纳入研究.根据患者入院时的容量负荷检查结果进行分组,将发生容量反应的患者纳入有容量反应组(19 例),将未发生容量反应的患者纳入无容量反应组(41 例).对比两组患者下腔静脉内径[呼气末最大下腔内径(IVCDmax)、呼气末最小下腔内径(IVCDmin)],计算下腔静脉内径呼吸变异度(Respiratory variability of inferior vena cava,RVI);心脏超声检测指标[每搏输出量(Stroke volume,SV)、心排血量(Cardiac output,CO)、心率(Heart Rate,HR)、平均动脉压(Mean arterial pressure,MAP)];采用受试者工作特征(ROC)曲线分析RVI、心脏超声指标对ICU脓毒症患者容量反应性异常的预测价值.结果:有容量反应组IVCDmax、IVCDmin小于无容量反应组,RVI水平高于无容量反应组(P<0.05);有容量反应组患者SV、CO水平低于无容量反应组(P<0.05),两组患者HR、MAP水平差异不明显(P>0.05);经ROC分析RVI、SV、CO的有容量反应性的曲线下面积分别为0.882、0.714、0.858,敏感度分别为86.67%、84.00%、85.77%,特异性分别为86.67%、42.88%、72.22%(P<0.05).结论:心脏超声结合下腔静脉内径呼吸变异度在预测 ICU 脓毒症患者容量反应性的临床价值明显,安全有效地提高临床上对 ICU 脓毒症患者容量反应性预测的准确性.
Objective:To investigate the clinical value of cardiac ultrasound combined with internal diameter respiratory variability of inferior vena cava in predicting volume reactivity in patients with sepsis in intensive care unit(ICU).Methods:60 patients with ICU sepsis who received treatment in our hospital from January 2021 to May 2023 were included in the study.Patients were grouped according to the results of volumetric load examination at admission.Patients with volumetric response were included in the volumetric response group(19 cases),and patients without volumetric response were included in the non-volumetric response group(41 cases).The Respiratory variability of inferior vena cava(RVI)was calculated by comparing the internal diameter of inferior vena(IVCDmax and IVCDmin)of the two groups.Cardiac ultrasound detection indicators[Stroke volume(SV),Cardiac output(CO),Heart Rate(HR),Mean arterial pressure(MAP)];Receiver operating characteristic(ROC)curve was used to analyze the predictive value of RVI and echocardiographic indexes for volume reactivity abnormalities in ICU sepsis patients.Results:IVCDmax and IVCDmin in volume-free group were lower than those in volume-free group,and RVI levels were higher than those in volume-free group(P<0.05).SV and CO levels in voluminous response group were lower than those in non-voluminous response group(P<0.05),and HR and MAP levels were not significantly different between the two groups(P>0.05).The area under the curve of volume reactivity of RVI,SV and CO by ROC analysis were 0.882,0.714 and 0.858,the sensitivity was 86.67%,84.00%and 85.77%,and the specificity was 86.67%,42.88%and 72.22%,respectively(P<0.05).Conclusion:Cardiac ultrasound combined with internal diameter respiratory variation of inferior vena cava has obvious clinical value in predicting volumetric reactivity in patients with sepsis in ICU,and can safely and effectively improve the accuracy of predicting volumetric reactivity in patients with sepsis in ICU.