内静脉缩性不能预测心脏手术后自发呼吸的患者的液体反应能力
Jan Horejsek1, Martin Balík1, Jan Kunstýř1
1Department of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, 12808, Czech Republic.
Journal of clinical monitoring and computing
|August 12, 2023
概括
内静脉 (IJV) 收缩性在心脏手术后自发呼吸的患者中没有准确预测液体反应. 这种超声波方法在指导流体治疗中显示出较低的诊断准确性.
科学领域:
- 临界护理医学 临界护理医学
- 心血管外科心血管外科
- 诊断成像 诊断成像 诊断成像
背景情况:
- 在术后心脏手术患者中,评估液体反应能力至关重要.
- 预测流体反应的非侵入性方法非常受欢迎.
- 内静脉 (IJV) 缩性是一种潜在的基于超声波的预测指标.
研究的目的:
- 为了评估内静脉 (IJV) 收缩性的诊断准确性.
- 为了确定IJV缩性是否预测心脏手术后自发呼吸患者的液体反应.
主要方法:
- 一项前性观察性研究,包括冠状动脉旁路移植后的54名患者.
- 超声波评估IJV可折叠性和血液动力学监测 (心脏指数,中风体积).
- 被动抬腿试验 (PLR) 用于诱导流体负荷;流体反应率定义为心脏指数增加≥10%.
主要成果:
- 17名患者 (31.5%) 被确定为流体反应者.
- 基线IJV直径在响应者和非响应者之间有所不同,但可折叠性相似 (P=0.7).
- IJV崩性 (截止值为20%) 的预测值很低 (灵敏度为76.5%,特异性为38.9%,ROC AUC为0.55).
结论:
- 内静脉缩性不是液体反应的可靠预测指标.
- 这一发现适用于接受手术冠状动脉再血管化的自发呼吸患者.
- 可能需要进一步的研究来探索其他非侵入性流体响应预测器.
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