中枢静脉压力可以帮助在机械通风的重症患者中识别急性右心室功能障碍吗?
Hongmin Zhang1, Hui Lian2, Qing Zhang3
1Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China. zhanghongmin1@pumch.cn.
Annals of intensive care
|July 20, 2024
概括
中心静脉压 (CVP) 可以帮助识别严重病情患者的右心室 (RV) 功能障碍与拥堵. 然而,CVP对一般VR功能障碍的准确性较低,因此应谨慎解释.
科学领域:
- 关键护理医学 关键护理医学
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
背景情况:
- 急性右心室 (RV) 功能障碍在接受机械通风的重症患者中很常见.
- 中枢静脉压力 (CVP) 是一个常见的监测参数,但其在评估RV功能的实用性是有争议的.
研究的目的:
- 调查机械通风重症患者中CVP和急性RV功能障碍之间的关系.
- 为了确定CVP在识别RV功能障碍的准确性,并没有系统性静脉拥堵.
主要方法:
- 对518名机械通风的重症患者进行了回顾性研究.
- 对RV功能 (TAPSE,FAC,S) 和系统静脉拥堵 (IVCD,HV多普勒) 的心声评估.
- 将患者分为正常的RV功能,孤立的RV功能障碍和RV功能障碍与拥堵组.
主要成果:
- CVP显示了良好的RV功能障碍与拥堵的区分能力 (AUC 0.839),最佳切断值为10毫米升.
- 对于确定所有VR功能障碍的患者,CVP的准确性有限 (AUC为0.616).
- 在两项分析中都观察到CVP的显著"灰色区域",限制了其精确的解释.
结论:
- 在机械通风患者中,CVP可能是RV功能障碍与全身静脉拥堵的有用指标,但其准确性有限.
- 低于10毫米升的CVP可以帮助排除RV功能障碍与拥堵.
- 不应仅仅依靠CVP来确定一般的RV功能障碍.
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