文章摘要
超声测量下腔静脉内径快速评估老年患者术前血容量的价值
Usefulness of ultrasonographic measurement of the diameter of the inferior vena cava to predict preoperative blood volume in elderly patients
  
DOI：10.12089/jca.2018.12.003
中文关键词: 超声  下腔静脉  老年患者  血容量
英文关键词: Ultrasonographic  Inferior vena cava  Elderly patients  Blood volume
基金项目:
作者单位E-mail
黄昌云 230022,合肥市,安徽医科大学第一附属医院麻醉科  
韩晓雨 230022,合肥市,安徽医科大学第一附属医院麻醉科  
方攀攀 230022,合肥市,安徽医科大学第一附属医院麻醉科  
方琪 230022,合肥市,安徽医科大学第一附属医院麻醉科  
刘学胜 230022,合肥市,安徽医科大学第一附属医院麻醉科 liuxuesheng@ahmu.edu.cn 
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中文摘要:
      
目的 探讨应用超声测量下腔静脉(IVC)横切面内径及面积,快速评估老年患者术前血容量的价值。
方法 选择择期胃肠手术老年患者90例,男47例，女43例，年龄65～80岁，ASA Ⅰ—Ⅲ级,根据入室后CVP分为低血容量组(CVP<5 cmH2O)和非低血容量组(CVP≥5 cmH2O)。采用超声测量患者剑突下呼气末IVC横切面的长径(LD)、短径(SD)及其横切面面积(Area),并计算IVC的内径形变指数(SCI),采用Pearson相关分析IVC各参数与CVP的相关性;绘制受试者工作特征(ROC)曲线确定IVC预测 CVP<5 cmH2O 的效能。
结果 低血容量组呼气末LD、SD、Area均明显小于非低血容量组(P<0.01),SCI明显高于非低血容量组(P<0.01)。LD、SD、SCI、Area与CVP相关系数r分别为0.346、0.754、-0.679、0.534(P<0.01)。ROC曲线预测CVP< 5 cmH2O时,SCI和SD曲线下面积(AUC)分别为0.925、0.893,明显优于LD、Area(0.669、0.717,P<0.01);SCI和SD的AUC差异无统计学意义。
结论 超声测量IVC横切面SD、SCI和Area在一定程度上能够为老年患者术前血容量评估提供参考,且SD和SCI预测老年患者术前血容量的效能更高。
英文摘要:
      
Objective To evaluate the value of preoperative blood volume in elderly patients using ultrasound measuring the cross section diameter and area of the inferior vena cava (IVC).
Methods Ninety patients who underwent elective gastrointestinal surgery, 47 males and 43 females, aged 65 - 80 years, ASA physical status Ⅰ - Ⅲ, were enrolled in the study. According to the preoperative CVP level, the patients were divided into hypovolemia group (CVP < 5 cmH2O) and non-hypovolemia group (CVP≥5cmH2O). IVC was measured during expiration breathing by ultrasonography on transversal plane from subcostal view. The length diameter (LD), short diameter (SD), the ratio of LD to SD as the shape change index (SCI), and cross section area (Area) of the IVC were recorded. Correlation between IVC and CVP was calculated by Pearson correlation coefficient. The receiver operating characteristic (ROC) curve was employed to analyze IVC parameters to predict the value of blood volume.
Results The hypovolemia group had lower LD, SD, Area, yet higher SCI than non-hypovolemia group (P < 0.01). CVP showed a positive correlation with LD, SD, Area (r = 0.346, 0.754, 0.534, respectively, P < 0.01) and a negative correlation with SCI (r = -0.679, P < 0.01). When the ROC curve predicted CVP < 5 cmH2O, the area under curve (AUC) of SCI, SD was 0.925 and 0.893, respectively, significantly better than LD and Area (0.669, 0.717, P < 0.01). There was no significant difference between the AUC of SCI and SD.
Conclusion Ultrasonographic measurement of IVC cross section diameter and area can provide reference for blood volume assessment, SCI and SD present significant capacities to predict the preoperative blood volume in elderly patients.
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