内静脉的床边超声波以评估液体状况和右心室功能:POCUS-JVD研究
Gaurang Nandkishor Vaidya1, Andrew Kolodziej2, Benjamin Stoner2
1Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America; Cardiac Amyloidosis Program, University of Kentucky, Lexington, KY, United States of America.
The American journal of emergency medicine
|June 12, 2023
概括
内静脉的治疗点超声波 (POCUS) 提供了一种可靠的床边方法,用于估计心力衰竭患者的液体状况. 这种技术有助于评估右心房压力 (RAP) 和右心室功能,改善患者管理.
科学领域:
- 心脏病学 心脏病学
- 临界护理医学 临界护理医学
- 在护理地点进行超声波 (POCUS)
背景情况:
- 准确的液体状况评估对于管理心力衰竭患者至关重要.
- 目前用于液体状态评估的床边方法通常不可靠或不适合日常使用.
研究的目的:
- 为了评估内静脉 (IJV) 治疗点超声波 (POCUS) 的有用性,以估计患者的液体状况.
- 评估IJV超声波参数与侵入性血液动力学测量,如右心房压力 (RAP) 和肺动脉脉动指数 (PAPi) 之间的相关性.
主要方法:
- 招募了176名非通风患者,计划进行右心导管注射 (RHC).
- 使用IJV的M模式超声波来测量正常呼吸过程中的直径,并评估呼吸变异 (RVD) 和吸入鼻子 (COS) 的折叠性.
- 还进行了下腔静脉 (IVC) 评估和肺动脉脉动指数 (PAPi) 的计算.
主要成果:
- IJV的POCUS在5分钟内在所有患者中都是可行的.
- 特定的IJV参数 (IJV Dmax≥1.2厘米或IJV-RVD<30%) 显示高RAP (≥10 mmHg) 的特异性>70%.
- 结合IJV POCUS和体检,RAP ≥10 mmHg的特异性提高到97%;IJV-COS对正常RAP (<10 mmHg) 的特异性为88%.
- IJV-RVD <30%对PAPi <3表现出76%的灵敏度和73%的特异性,这表明在评估RV功能方面具有实用性.
结论:
- IJV的POCUS是临床实践中日常流体状况估计的实用,具体和可靠的方法.
- 建议IJV-RVD<30%作为估计RAP≥10mmHg和PApi<3的有用切线,有助于心力衰竭的管理.
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