标题：超声监测不同部位静脉变异度评估患者有效血容量的研究

      作者：张华东 1，2，张卫星 1，3    (1.汕头大学医学院，广东 汕头 515041；,2.深圳市人民医院重症医学科，广东 深圳 518020；3.北京大学深圳医院重症医学科，广东 深圳 518000)

      卷次： 2018年29卷20期

      【摘要】 目的 探讨颈内静脉、腋静脉、下腔静脉及股静脉变异度对患者有效血容量评估的价值。方法 选择2018年1~6月深圳市人民医院 ICU收治的80例患者为研究对象，入选患者均经超声监测颈内静脉、腋静脉、下腔静脉及股静脉内径呼吸变异度、横截面面积变异度、血流频谱变异度，行补液试验，根据结果分为容量反应组(n=26)和容量无反应组(n=54)，监测补液前后两组患者的血流动力学变化，并判断患者的容量反应性。结果 容量反应组患者颈内静脉、腋静脉、下腔静脉内径呼吸变异度、横截面面积变异度、血流频谱变异度明显高于容量无反应组，差异均有统计学意义(P<0.05)；两组患者的股静脉内径呼吸变异度[(22.7±2.0)% vs (21.9±1.7)%]和横截面积变异度[(22.9±2.1)% vs (22.1±1.9)%]比较差异均无统计学意义(P>0.05)，而容量反应组患者的血流频谱变异度明显高于容量无反应组[(44.5±6.8)% vs (23.6±4.5)%]，差异有统计学意义 (P<0.05)；容量反应组患者的血压[收缩压：(11.9±2.8) mmHg vs (6.5±2.1) mmHg；舒张压：(5.6±1.6) mmHg vs (4.2±1.4) mmHg]、24 h尿量[(0.9±0.3) mL/(kg·h) vs(0.6±0.2) mL/(kg·h)]及乳酸清除率[(62.7±11.8)% vs (36.5±7.6)%]比较，容量反应组患者的改善程度明显优于容量无反应组，差异均有统计学意义(P<0.05)。结论 颈内静脉、腋静脉、下腔静脉、股静脉内径呼吸变异度、横截面面积变异度、血流频谱变异度与患者容量反应性密切相关，可用于临床上指导补液治疗。
      【关键词】 颈内静脉；腋静脉；下腔静脉；股静脉；变异度；彩色多普勒超声；容量反应性
      【中图分类号】 R543.6 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2844—03

Study on ultrasound monitoring of venous variability at different parts of the body to assess the effective volumeof blood in patients.
ZHANG Hua-dong1,2, ZHANG Wei-xing 1,3. 1. Shantou University Medical College, Shantou 515041,Guangdong, CHINA; 2. Department of Critical Care Medicine, Shenzhen People's Hospital, Shenzhen 518020, Guangdong,CHINA; 3. Department of Critical Care Medicine, Peiking University Shenzhen Hospital, Shenzhen 518000, Guangdong, CHINA
【Abstract】 Objective To explore the clinical application value of variability of internal jugular vein, axillaryvein, inferior vena cava and femoral vein in evaluating the effective blood volume of patients. Methods A total of 80patients admitted to ICU of Shenzhen People's Hospital from January 2018 to June 2018 were selected as subjects. Theselected patients were monitored by ultrasonography for internal diameter respiratory variability, cross-sectional areavariability, and blood flow spectrum variability of the internal jugular vein, axillary vein, inferior vena cava and femoralvein, and rehydration test were performed. According to the results, they were divided into a volume response group (n=26) and a volume non-response group (n=54). Hemodynamic changes were monitored in the two groups before and afterfluid infusion, and the volume responsiveness of patients was determined. Results The internal diameter respiratoryvariability, cross-sectional area variability and blood spectrum variability of the internal jugular vein, axillary vein and in-ferior vena cava in the volume response group were significantly higher than those in the volume non-response group (P<0.05). The internal diameter respiratory variability, cross-sectional area variability in femoral vein showed no significantdifference between the two groups: (22.7±2.0)% vs (21.9±1.7)%, (22.9±2.1)% vs (22.1±1.9)%, respectively; P>0.05.The blood spectrum variability of patients in the volume response group was significantly higher than that in the vol-ume non-response group: (44.5±6.8)% vs (23.6±4.5)%, P<0.05. Compared with the volume response group, the im-provement of blood pressure in patients [systolic pressure: (11.9±2.8) mmHg vs (6.5±2.1) mmHg; diastolic pressure:(5.6±1.6) mmHg vs (4.2±1.4) mmHg], 24 h urine volume [(0.9±0.3) mL/(kg·h) vs (0.6±0.2) mL/(kg·h)] and lactate clear-ance rate [(62.7 ± 11.8)% vs (36.5 ± 7.6)% ] were significantly better than those in the volume non-response group (P<0.05). Conclusion The internal diameter respiratory variability, cross-sectional area variability, the blood spectrum vari-ability of the internal jugular vein, axillary vein, inferior vena cava and femoral vein have close correlations with patientvolume responsiveness, and can be used to guide clinical rehydration therapy.
      【Key words】 Internal jugular vein; Axillary vein; Inferior vena cava; Femoral vein; Variability; Color doppler ul-trasound; Volume responsiveness·论 著·doi:10.3969/j.issn.1003-6350.2018.20.010