摘要
目的 于剑突下和右侧腹腋中线超声观察纵切面不同呼吸状态下的下腔静脉内径及变异度,探讨两个部位、不同呼吸状态间的相关性.方法 选2013年11-12月连续入住北京协和医院重症医学科的患者127例,分别于剑突下和右侧腹腋中线部位超声观测纵切面不同呼吸状态下的下腔静脉内径值,计算其变异度.结果 （1）127例患者中采用右侧腹腋中线观察下腔静脉者124例（占97.6％）,采用剑突下观察下腔静脉者83例（占65.4％）,两者比较差异有统计学意义（x2=74.42,P＜0.01）;两个部位同时检查者81例,其中自主呼吸者44例,机械通气者37例.（2）机械通气者、自主呼吸者右侧腹腋中线与剑突下的下腔静脉内径值在呼气末、吸气末及变异度比较差异均有统计学意义（P均＜0.05）.（3）选机械通气者剑突下呼气末下腔静脉内径值≥2 cm者,右侧腹腋中线下腔静脉内径值为（2.25 ±0.32） cm,剑突下为（2.10 ±0.12） cm,差异无统计学意义（P =0.083）.选自主呼吸者剑突下呼气末下腔静脉内径值≥2 cm者,2个部位呼气末、吸气末下腔静脉内径值比较差异无统计学意义（P均＞0.05）,变异度比较差异有统计学意义（P均＜0.05）.选机械通气者剑突下呼气末下腔静脉内径值≤1.5 cm者,右侧腹腋中线下腔静脉内径值为（1.58 ±0.43） cm,剑突下为（1.09±0.38）cm,差异有统计学意义（P =0.026）.选自主呼吸者剑突下呼气末下腔静脉内径值≤1.5 cm者,2个部位呼气末、吸气末下腔静脉内径值、变异度比较差异有统计学意义（P均＜0.05）.（4）相关性分析：①机械通气者：右侧腹腋中线呼气末下腔静脉内径值与剑突下呼气末下腔静脉内径值相关（r =0.565,P=0.000）.②自主呼吸者：右侧腹腋中线呼气末下腔静脉内径值与剑突下呼气末下腔静脉内径值相关（r =0.526,P=0.000）,右侧腹腋中线吸气末下腔静脉内径值与剑突下吸气末下腔静脉内径值相关（r =0.454,P=0.002）,右侧腹腋中线下腔静脉内径变异度与剑突下下腔静脉内径变异度相关（r =0.513,P=0.000）.结论 剑突下与右侧腹腋中线超声观测纵切面下腔静脉内径及变异度存在差异,无法互相替代.如果以右侧腹腋中线观测结果指导临床工作存在一定问题,需更深入的研究.
Objective To investigate the inferior vena cava internal diameter （IVCID） and inferior vena cava variability （IVCV） on longitudinal plane measured from subcostal area and right mid-axillary line through ultrasonography and to find out if the measuring site and different respiratory status were related to the IVCID and IVCV.Methods A total of 127 patients were enrolled successively in Critical Care Medical Department of Peking Union Medical Hospital from November to December,2013.IVCID and IVCV of patients on mechanical ventilation or with spontaneous breathing were measured longitudinally from subcostal area and right mid-axillary line.Results （1）Totally 124 out of the 127 patients achieved measurement from right mid-axillary line,while only 83 patients achieved measurement from subcostal area.The difference was statistically significant（x2 =74.42,P 〈 0.01）.Eighty-one patients can be measured from both sites,with 44 had spontaneous breathing and 37 on mechanical ventilation.（2）Whether in spontaneous or mechanically ventilated patients,IVCID measured from subcostal area was statistically different from right mid-axillary line measurement at both end expiration and end inspiration.（3） In mechanically ventilated patients with IVCID ≥2 cm measured from subcostal area at end expiration,no statistical difference was found between the IVCID from right mid-axillary line and from subcostal area[（2.25 ±0.32）cm vs （2.10 ± 0.12）cm,P =0.083].In spontaneous breathing patients with IVCID ≥2 cm measured from subcostal area at end expiration,there were significant differences between the IVCID from right mid-axillary line and from subcostal area at both end expiration and end inspiration.The IVCV between the two sites were also statistically different.In mechanically ventilated patients with IVCID ≤ 1.5 cm measured from subcostal area at end expiration,there were significant difference between the IVCID from right mid-axillary line and from subcostal area [（1.58 ± 0.43） cm vs （1.09 ± 0.38） cm,P =0.026].In spontaneous breathing patients with IVCID ≤ 1.5 cm measured from subcostal area at end expiration,there were significant difference between the IVCID from right mid-axillary line and from subcostal area at both end expiration and end inspiration.The IVCV between the two sites were also statistically different.（4） Correlation analysis showed in mechanically ventilated patients,IVCID measured from right mid-axillary line at end expiration was correlated with the IVCID measured from subcostal area at end expiration （r =0.565,P =0.000）.In spontaneous breathing patients,IVCID measured at end expiration from right mid-axillary line was correlated with the IVCID measured from subcostal area（r =0.526,P =0.000）.IVCID measured at end inspiration from right mid-axillary line was correlated with the IVCID measured from subcostal area （r =0.454,P =0.002）.IVCV measured from right mid-axillary line was correlated with IVCV measured from subcostal area （r =0.513,P =0.000）.Conclusions Inferior vena cava internal diameter and variability measured longitudinally through ultrasonography from subcostal area is different with measurements from right midaxillary line.Measurements from the two sites are not replaceable with each other.Further studies are needed before the clinical use of inferior vena cava internal diameter and variability measured from right midaxillary line.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2014年第11期880-883,共4页
Chinese Journal of Internal Medicine
基金
卫生部卫生行业科研专项经费资助（201202011）
关键词
超声检查
腔静脉
下
内径
下腔静脉变异度
Ultrasonography
Vena cava, inferior
Internal diameter
Variability of the inferior vena cava
