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目的:对B超检测“下腔静脉呼吸塌陷指数”(IVC-CI)预测神经重症患者容量反应性的效能进行评价。方法:2016年6月至2017年2月入住神经重症监护室(NICU)的合并休克的神经重症患者53名,在液体复苏前(6%羟乙基淀粉氯化钠溶液7ml/kg,静脉滴注,20分钟滴完),分别行B超监测IVC-CI以及Pi CCO监测心指数(Cardiac Index,CI),以补液前后CI增长≥15%作为具有容量反应性的参考标准,绘制IVC-CI预测容量反应性的ROC曲线。结果:补液前GEDVI预测容量反应性曲线下面积0.59,介入0.5-0.7之间,被认为诊断价值较低。而补液前IVC-CI预测容量反应性曲线下面积0.71,被认为诊断价值中等。IVC-CI最佳截取值为24%,诊断敏感度0.79,特异性0.64。结论:超声测量的IVC-CI,作为一种便捷、无创、重复性好的判断休克患者容量反应性的工具,可用于神经重症合并休克患者的容量反应性预测。
OBJECTIVE: To evaluate the efficacy of B-ultrasound and IVC-CI in predicting volume responsiveness in patients with neuroticism. METHODS: Fifty-three neurotic patients with shock in the Intensive Care Unit (NICU) from June 2016 to February 2017 were divided into two groups: pre-fluid resuscitation (6ml hydroxyethyl starch sodium chloride solution 7ml / kg, intravenous drip (20 minutes). IVC-CI and PiCCO Cardiac Index (CI) were monitored by B-mode ultrasonography and CI-CI ROC curve for predicting capacity reactivity. RESULTS: The area under the predicted volume response curve for GEDVI before rehydration was 0.59, with intervention between 0.5 and 0.7, and was considered as a lower diagnostic value. However, IVC-CI predicts an area under the capacity response curve of 0.71 before rehydration, which is considered to be of diagnostic value. The best IVC-CI cut-off was 24% with a diagnostic sensitivity of 0.79 and a specificity of 0.64. CONCLUSIONS: IVC-CI measured by ultrasound is a convenient, noninvasive and reproducible tool for judging the volume responsiveness in patients with shock and can be used to predict the volume responsiveness in patients with severe neurological shock.