关键词:

下腔静脉, 腹主动脉, 颈动脉校正血流时间, 脓毒症休克, 容量反应

Abstract:

Objective　To evaluate the value of the ratio of the maximum diameter of the inferior vena cava at end-expiration (IVCmax) to the maximum internal diameter of the abdominal aorta during systole (IVC/Ao) and the corrected flow time of the carotid artery (FTc) in predicting volumetric response in patients with septic shock. Methods　A total of 86 patients with septic shock were included in Xi'an Central Hospital from June 2020 to June 2023, and the stroke output (SV) before and after the volume loading test was monitored by transthoracic echocardiography, and the SV added value (ΔSV) was calculated. In the volume-responsive group (ΔSV≥15%), there were 28 males and 17 females, aged (63.21±6.95) years. In the non-responsive group (ΔSV <15%), there were 24 males and 17 females, aged (64.17±7.24) years. The IVC/Ao, mean arterial pressure (MAP), central venous pressure (CVP), heart rate, FTc, and variation in peak carotid artery flow velocity (ΔVpeak-CA) were recorded before and after the test. The correlations between IVC/Ao, FTc, ΔVpeak-CA, and ΔSV before the test were analyzed. Their predictive value for volume responsiveness in septic shock patients was analyzed by receiver operating characteristic curve (ROC). Statistical methods used were χ² test and t test. Results　The FTc in the responsive group was higher after the test than that before the test (t=4.63, P<0.001). Before the test, the inferior vena cava collapse index (IVCCI), IVC/Ao, and ΔVpeak-CA in the responsive group were higher than those in the non-responsive group [(28.77±3.36) vs. (14.20±3.87), (1.55±0.16) vs. (1.19±0.12), and (12.81±4.59)% vs. (8.04±4.29)%], with statistically significant differences (t=18.68, 11.71, and 4.97, all P<0.05). ΔSV was negatively correlated with FTc and was positively correlated with IVC/Ao, ΔVpeak-CA, and IVCCI (all P<0.001). Nomogram model results suggested a higher risk of volume non-responsiveness in patients with higher FTc level and lower IVC/Ao, ΔVpeak-CA, and IVCmax levels. ROC analysis indicated that the combined predictive value of these indicators for volume responsiveness had an area under the curve (AUC) of 0.946. Conclusion　The IVC/Ao ratio and carotid FTc are effective predictors of volume responsiveness in septic shock patients and can be utilized as valuable clinical tools for determining the need for fluid resuscitation in these patients.

Key words:

Inferior vena cava, Abdominal aorta, Corrected carotid artery flow time, Septic shock, Volume responsiveness