叶 飞,王永广,葛志鹏,刘兰鹏,甘桂芬

尽管经过数十年的研究，脓毒症和脓毒症休克的死亡率仍然高得令人无法接受。诊断延迟、感染源识别以及提供患者定制复苏措施的挑战通常导致患者结局不佳。床旁超声提高了临床医生诊断和管理脓毒症患者的能力。超声测量下腔静脉变异度的评价方式简洁、高效，为临床医师提供了一个动态无创的预测容量的方式，近些年在临床上广泛应用。目前已有多项研究证实其临床实用性与准确性，但仍存在争议。本文就下腔静脉变异度评估容量状态在临床应用价值及局限性进行综述。

下腔静脉；脓毒症；容量反应性

[1] Kim DW,Chung S,Kang WS,Kim J.Diagnostic Accuracy of Ultrasonographic Respiratory Variation in the Inferior Vena Cava,Subclavian Vein,Internal Jugular Vein,and Femoral Vein Diameter to Predict Fluid Responsiveness:A Systematic Review and Meta-Analysis[J].Diagnostics(Basel),2021,12(1). [2] Barbier C,Loubières Y,Schmit C,et al.Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients[J].Intensive Care Med,2004,30(9):1740-1746. [3] Rudski LG,Lai WW,Afilalo J,et al.Guidelines for the echocardiographic assessment of the right heart in adults:a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography,a registered branch of the European Society of Cardiology,and the Canadian Society of Echocardiography[J].J Am Soc Echocardiogr,2010,23(7):685-713;quiz 786-688. [4] Preau S,Bortolotti P,Colling D,et al.Diagnostic Accuracy of the Inferior Vena Cava Collapsibility to Predict Fluid Responsiveness in Spontaneously Breathing Patients With Sepsis and Acute Circulatory Failure[J].Crit Care Med,2017,45(3):e290-e297. [5] Rivers E,Nguyen B,Havstad S,et al.Early goal-directed therapy in the treatment of severe sepsis and septic shock[J].N Engl J Med,2001,345(19):1368-1377. [6] Ghosh S,Padhi R,Sahu S,et al.Use of inferior vena cava guided fluid therapy in the treatment of septic shock:A randomised controlled trial[J].J Infect Dev Ctries,2024,18(1):75-81. [7] Doucet JJ,Ferrada P,Murthi S,et al.Ultrasonographic inferior vena cava diameter response to trauma resuscitation after 1 hour predicts 24-hour fluid requirement[J].J Trauma Acute Care Surg,2020,88(1):70-79. [8] Muller L,Bobbia X,Toumi M,et al.Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure:need for a cautious use[J].Crit Care,2012,16(5):R188. [9] Si X,Xu H,Liu Z,et al.Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness in Mechanically Ventilated Patients?A Systematic Review and Metaanalysis[J].Anesth Analg,2018,127(5):1157-1164. [10] Alvarado Sánchez JI,Caicedo Ruiz JD,Diaztagle Fernández JJ,et al.Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes:systematic review and meta-analysis[J].Ann Intensive Care,2021,11(1):28. [11] Campos NB,De Lima LB,Ferraz IS,et al.Accuracy of Respiratory Variation in Inferior Vena Cava Diameter to Predict Fluid Responsiveness in Children Under Mechanical Ventilation[J].Pediatr Cardiol,2023. [12] Mookadam F,Warsame TA,Yang HS,et al.Effect of positional changes on inferior vena cava size[J].Eur J Echocardiogr,2011,12(4):322-325.

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