重新审视体积响应:对连续结果与二进制结果的观察性多中心研究,结合了心声学和静脉回归生理学
Anders Aneman1,2,3, Luis Schulz1,2, Gwenaël Prat4
1Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia.
American journal of physiology. Heart and circulatory physiology
|September 8, 2023
概括
心声学可以更好地评估流体响应性,通过测量连续的中风体积变化和静脉回归压力梯度. 这种方法识别了混因素,如右心室功能受损和腹内高血压.
科学领域:
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
- 医学成像医学成像
背景情况:
- 心声图用于评估急性循环衰竭的流体服药期间的心脏预负荷.
- 目前的临床研究经常使用二进制定义的中风体积 (SV) 变化,可能过度简化流体响应.
- 静脉回归生理学,包括静脉回归的压力梯度 (VRdP),对于理解静脉回归动态至关重要.
研究的目的:
- 测试计算模拟平均系统填充压力 (Pmsa) 和VRdP是否可以增强回声心脏学来评估对预加载挑战的SV反应.
- 调查右心室功能障碍 (impRV) 和腹内高血压 (IAH) 对这些心声回声评估的影响.
- 为了比较拟议的连续SV变化方法与传统的二进制定义的体积响应.
主要方法:
- 研究了540名接受被动抬腿 (PLR) 操作的患者.
- 利用多变量线性回归来识别与 SV 变化相关的独立变量.
- 根据impRV或IAH的存在来对患者进行分类,以分析混杂效应.
- 使用二进制 SV 变化截止值 (>10%) 的逻辑回归与 Pmsa 和 VRdP 分析进行比较.
主要成果:
- VRdP,上静脉腔直径的呼吸器诱导变化和左心室外流通道最大多普勒速度独立地与SV变化有关.
- 该模型解释了整个队列中38%的SV变化,当排除impRV或IAH患者时,增加到64%.
- 随着impRV或IAH的增加,Pmsa/VRdP和SV变化之间的相关性显著减少.
- 一个二进制的SV变化定义未能将Pmsa或VRdP识别为独立变量,并忽略了混因素.
结论:
- 静脉回归生理学,包括Pmsa和VRdP,可以增强回声心脏学对体积响应性的评估.
- 音量响应的心声回声评估最好是基于持续的SV变化.
- 该研究确定了impRV和IAH对SV响应预测的混影响,这些影响被二进制SV变化切断值遗漏了.
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