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中华医学超声杂志(电子版) ›› 2024, Vol. 21 ›› Issue (06) : 624 -629. doi: 10.3877/cma.j.issn.1672-6448.2024.06.012

综述

下腔静脉超声测量及其评估血管内容量的研究进展
李彩虹1, 包玉华2, 王小贤3, 徐芳3, 李明霞3, 葛贝贝3, 徐瑞雪3, 姚静3,()   
  1. 1. 210029 南京大学医学院附属鼓楼医院超声科;225200 扬州市江都中医院超声科
    2. 225200 扬州市江都中医院超声科
    3. 210029 南京大学医学院附属鼓楼医院超声科
  • 收稿日期:2024-03-07 出版日期:2024-06-01
  • 通信作者: 姚静

Advances in ultrasonic measurement of the inferior vena cava and its application in evaluation of intravascular volume

Caihong Li, Yuhua Bao, Xiaoxian Wang   

  • Received:2024-03-07 Published:2024-06-01
引用本文:

李彩虹, 包玉华, 王小贤, 徐芳, 李明霞, 葛贝贝, 徐瑞雪, 姚静. 下腔静脉超声测量及其评估血管内容量的研究进展[J]. 中华医学超声杂志(电子版), 2024, 21(06): 624-629.

Caihong Li, Yuhua Bao, Xiaoxian Wang. Advances in ultrasonic measurement of the inferior vena cava and its application in evaluation of intravascular volume[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(06): 624-629.

对于住院患者,尤其是急重症患者,快速判断其容量状态并适当补液进行液体复苏至关重要,盲目液体复苏不利于患者预后[1]。当机体容量不足而得不到足量补充时,将增加器官灌注不足的风险[2];而容量过量致机体容量超负荷可能导致器官充血和功能障碍[3]。现在临床常通过测量中心静脉压(central venous pressure,CVP)、下腔静脉内径(inferior vena cava diameter,IVCd)及下腔静脉塌陷指数(IVC collapsibility index,IVCCI)来判断患者血管内容量。CVP测量为有创检查,而超声测量IVC因具有无创、简便、快速、可重复性高等优点日益受到关注,在临床得到广泛应用。但是IVC的超声测量方法、影响因素及其临床意义目前尚存争议。本文就近年来IVC超声测量方法、影响因素及其在临床实践中的应用进展进行综述。

图1 不同切面下腔静脉测量的超声图像。图a为剑突下经腹短轴切面(SA)肝静脉入口水平测量;图b为剑突下经腹短轴切面(SA)左肾静脉起始水平测量(箭头所指为左肾静脉起始段);图c为剑突下经腹长轴切面(LA),测量位置在距右心房2~3 cm处;图d为右侧腹冠状经肝长轴切面(CLA)测量注:IVC为下腔静脉;AO为主动脉;Liver为肝脏;Pancreas为胰腺
图2 呼吸运动对下腔静脉(IVC)测量结果的影响超声示意图。图a示当IVC收缩时是沿实线方向内外收缩,而非沿着虚线方向,α角约为115°;图b示当呼吸时IVC发生左右方向的位移,本来应在a位置测量,呼吸后可能在b位置测量,此时内径的变化是因测量位置发生变化而造成管径测值变小,并非呼吸时IVC本身管径变小;图c示用M型超声测量,当呼吸发生上下方向的位移时,本来应在c位置测量,呼吸后可能在d位置测量,以致产生误差
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