颈内静脉变异度和下腔静脉变异度评估成人心脏术后容量状态

黄平; 张萌; 吴洪坤; 陈灏

doi:10.13406/j.cnki.cyxb.003025

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颈内静脉变异度和下腔静脉变异度评估成人心脏术后容量状态

临床研究 | 更新时间：2022-06-24

- 颈内静脉变异度和下腔静脉变异度评估成人心脏术后容量状态
- Assessment of fluid responsiveness by variability index of internal jugular vena cava and variability index of inferior vena cava in adult petients with cardiosurgery
- 重庆医科大学学报 2022年47卷第5期页码：614-619
- 作者机构：
  
  1.中国科学院大学重庆医院/重庆市人民医院　重症医学科，重庆　401147
  2.中国科学院大学重庆医院/重庆市人民医院　心血管外科，重庆　401147
- 作者简介：
  
  黄平，Email：495202947@qq.com，研究方向：心脏术后脏器保护。
  吴洪坤，Email：wuhongkuncq@163.com。
- 基金信息：
  
  重庆市科卫联合医学科研资助项目(2020GDRC019);中国科学院大学（重庆医院）医学科技创新基金资助项目(Y2019MSXM08)
- DOI：10.13406/j.cnki.cyxb.003025
  中图分类号： R654.27
- 纸质出版日期：2022-05-28，
  
  收稿日期：2021-10-16，
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黄平, 张萌, 吴洪坤, 等. 颈内静脉变异度和下腔静脉变异度评估成人心脏术后容量状态[J]. 重庆医科大学学报, 2022,47(5):614-619.

Ping Huang, Meng Zhang, Hongkun Wu, et al. Assessment of fluid responsiveness by variability index of internal jugular vena cava and variability index of inferior vena cava in adult petients with cardiosurgery[J]. Journal of Shanxi Agricultural Sciences, 2022,47(5):614-619.
黄平, 张萌, 吴洪坤, 等. 颈内静脉变异度和下腔静脉变异度评估成人心脏术后容量状态[J]. 重庆医科大学学报, 2022,47(5):614-619. DOI： 10.13406/j.cnki.cyxb.003025.

Ping Huang, Meng Zhang, Hongkun Wu, et al. Assessment of fluid responsiveness by variability index of internal jugular vena cava and variability index of inferior vena cava in adult petients with cardiosurgery[J]. Journal of Shanxi Agricultural Sciences, 2022,47(5):614-619. DOI： 10.13406/j.cnki.cyxb.003025.

摘要

目的：

探索超声测量颈内静脉变异度（variability index of internal jugular vena cava，VJVC）、下腔静脉变异度（variability index of inferior vena cava，VIVC）评估心脏术后容量状态。

方法：

前瞻性连续纳入中国科学院大学重庆医院心血管外科成人心脏术后76例患者。超声测量被动抬腿实验（passive leg raising，PLR）前后患者心排指数，心排指数增加10%为标准，增加≥10%为容量有反应者（fluid responders，FR）；反之则为容量无反应者（fluid unresponders，FN）。同时记录患者PLR前后心率、收缩压、舒张压、平均压。在PLR前，查氨基末端脑利钠肽（N-terminal pro-brain natriuretic peptide，NT-proBNP），超声测量VIVC和左侧VJVC。

结果：

对比PLR前后，FR组中心静脉压在PLR前后无统计学差异［（7.6±1.9）mmHg vs.（10.1±11.4）mmHg，

=0.154］，心率［（83.0±8.9）次/min vs.（75.3±7.5）次/min，

=0.000］、收缩压［（91.1±9.4）mmHg vs.（94.9±9.1）mmHg，

=0.000］、舒张压［（52.8±9.8）mmHg vs.（58.9±8.2）mmHg，

=0.000］、平均压［（65.6±9.2）mmHg vs.（70.7±8.0）mmHg，

=0.000］均有明显变化。FN组PLR后收缩压的变化无统计学差异［（90.0±7.4）mmHg vs.（92.3±6.7）mmHg，

=0.076］，心率［（83.5±9.1）次/min vs.（80.7±7.4）次/min，

=0.005］、舒张压［（50.0±7.1）mmHg vs.（55.2±5.7）mmHg，

=0.000］、平均压［（63.3±6.8）mmHg vs.（67.6±5.0）mmHg，

=0.000］、中心静脉压［（7.9±1.6）mmHg vs.（10.2±1.4）mmHg，

=0.000］均有明显变化。对比FR组和FN组患者被动抬腿实验前（T

），心率、收缩压、舒张压、平均压、中心静脉压无统计学差异；被动抬腿实验后（T

），心率明显下降，FR组与FN组比较有统计学差异［（75.3±7.5）次/min vs.（80.7±7.4）次/min，

=0.001］，舒张压和平均压变化有统计学差异［（58.9±8.2）mmHg vs.（55.2±5.7）mmHg，

=0.014；（70.7±8.0）mmHg vs.（67.6±5.0）mmHg，

=0.024］，收缩压和中心静脉压无统计学差异［（94.9±9.1）mmHg vs.（92.3±6.7）mmHg，

=0.075；（10.1±11.4）mmHg vs.（10.2±1.4）mmHg，

=0.474］，2组间血浆NT-proBNP无统计学差异［（1 144.6±9 92.1）pg/mL vs.（1 243.6±1 095.0）pg/mL，

=0.335］。FR组和FN组VIVC有统计学差异［（15.2±3.9）% vs.（12.5±4.2）%，

=0.003］，FR组和FN组VJVC有统计学差异［（17.7±4.3）% vs.（13.9±4.0）%，

=0.000］。VIVC诊断容量有反应的临界值为11.5%，敏感性为87.8%，特异性为55%（曲线下面积为0.7，95% CI=0.575~0.826，

=0.003）。VJVC诊断容量有反应的临界值为15.5%，敏感性为68.3%，特异性为77.1%（曲线下面积为0.764，95% CI=0.654~0.874，

=0.000）。

结论：

颈内静脉变异度和下腔静脉变异度都能较好、及时地预测心脏术后患者容量状态，准确指导临床补液治疗。且颈内静脉比下腔静脉更容易测量，位置更加表浅，更加恒定，不受患者肥胖影响，不受腹压影响，无心脏术后引流管影响，重复性更好。临床工作中更推荐使用VJVC评估心脏术后容量状态。

Abstract

Objective

To evaluate the variability index of internal jugular vena cava (VJVC) and variability index of inferior vena cava (VIVC) through ultrasound in predicting fluid responsiveness in adult petients with cardiosurgery.

Methods

Prospectively

76 adult pa tients who had cardiosurgery in the Department of Cardiovascular Surgery

Chongqing General Hospital were collected in the study

and the passive leg raising (PLR) tests were carried out on them of intensive monitoring in the intensive care unit (ICU) ward. Patients with elevated cardiac output index≥10% after PLR were included in the fluid responders (FR) group

while patients with elevated cardiac output index<10% were included in the fluid unresponders (FN) group. Meanwhile

the hemodynamic parameters of heart rate

systolic blood pressure

diastolic blood pressure and mean blood pressure were all recorded before and after PLR tests in both groups. The N-terminal pro-brain natriuretic peptide (NT-proBNP)

VJVC

and VIVC were recorded before PLR tests.

Results

After PLR tests

in FR group

there were no significant differences in central venous pressure［ (7.6±1.9) mmHg vs. (10.1±11.4) mmHg

=0.154］; there were significant differences in heart rate［ (83.0±8.9) bpm vs. (75.3±7.5) bpm

=0.000］

systolic blood pressure［ (91.1±9.4) mmHg vs. (94.9±9.1) mmHg

=0.000］

diastolic blood pressure［ (52.8±9.8) mmHg vs. (58.9±8.2) mmHg

=0.000］

and mean blood pressure［ (65.6±9.2) mmHg vs. (70.7±8.0) mmHg

=0.000］. In FN group after PLR

there were no significant differences in systolic blood pressure［ (90.0±7.4) mmHg vs. (92.3±6.7) mmHg

=0.076］

and there were significant differences in heart rate［ (83.5±9.1) bpm vs. (80.7±7.4) bpm

=0.005］

diastolic blood pressure［ (50.0±7.1) mmHg vs. (55.2±5.7) mmHg

=0.000］

mean blood pressure［ (63.3±6.8) mmHg vs. (67.6±5.0) mmHg

=0.000］

and central venous pressure［ (7.9±1.6) mmHg vs. (10.2±1.4) mmHg

=0.000］. There were no significant differences in heart rate

systolic blood pressure

diastolic blood pressure

mean blood pressure and central venous pressure between FR goup and FN group before PLR tests. After PLR

there were no significant differences in systolic pressure［ (94.9±9.1) mmHg vs. (92.3±6.7) mmHg

=0.075］and central venous pressure［ (10.1±11.4) mmHg vs. (10.2±1.4) mmHg

=0.474］between the two groups

and there were significant differences in heart rate［ (75.3±7.5) bpm vs. (80.7±7.4) bpm

=0.001］

diastolic blood pressure［ (58.9±8.2) mmHg vs. (55.2±5.7) mmHg

=0.014］

and mean blood pressure［ (70.7±8.0) mmHg vs. (67.6±5.0) mmHg

=0.024］. In addition

There was no significant difference in plasma NT-proBNP between the two groups［ (1 144.6±992.1) pg/mL vs. (1 243.6±1095.0) pg/mL

=0.335］

and there were significant differences in VIVC［ (15.2±3.9) % vs. (12.5±4.2) %

=0.003］and VJVC［ (17.7±4.3) % vs. (13.9±4.0) %

=0.000］. The cutoff value of VIVC diagnostic capacity was 11.5%

the sensitivity was 87.8%

and the specificity was 55% (AUC=0.7

95% CI=0.575-0.826

=0.003) . The cutoff value of VJVC diagnostic capacity was 15.5%

the sensitivity was 68.3%

and the specificity was 77.1% (AUC=0.764

95% CI=0.654-0.874

=0.000) .

Conclusion

VIVC and VJVC can easily predict the noninvasive parameter of fuid responsiveness in patients with cardiosurgery and accurately guide the clinical rehydration therapy. Moreover

the internal jugular vein is easier to measure than the inferior vena cava

its position is shallower and more constant

and it is not affected by the obesity of patients

abdominal pressure and drainage tube after cardiosurgery

so the repeatability is better. It is more recommended to use the VJVC to evaluate the fluid responsiveness after cardiosurgery in clinical work.

关键词

颈内静脉变异度下腔静脉变异度心脏手术容量状态

Keywords

variability index of internal jugular vena cavavariability index of inferior vena cavacardiosurgeryfluid responsiveness

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