休克患者快速超声评估流程在评估心脏功能和容量反应性的价值

doi:10.3969/j.issn.1006-6233.2025.01.022

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摘要 目的: 分析休克患者快速超声评估流程(RUSH)在评估心脏功能和容量反应性的价值。方法: 选取2022年1月1日至2024年1月31日在宁夏回族自治区人民医院急诊科和重症医学科收治的100例休克患者为研究对象,观察RUSH方案对休克类型识别的诊断敏感度、特异性、阳性预测值、阴性预测值及准确率,分析不同休克患者机械通气时间、住院时间、院内病死率,心脏功能(入院时左室射血分数和休克纠正时左室射血分数)和容量反应性(下腔静脉直径及塌陷率和复苏1h后出现较多B线率)。结果: 经过RUSH方案检测心源性休克32例,敏感度、特异性及准确率分别为91.67%、98.68%、97.00%,低血容量休克33例,敏感度、特异性及准确率分别为91.67%、94.74%、94.00%,梗阻性休克15例,敏感度、特异性及准确率分别为95.00%、97.50%、97.00%,分布性休克20例,敏感度、特异性及准确率分别为90.63%、98.53%、96.00%;不同休克类型患者间机械通气时间与住院时间差异有统计学意义(P<0.05),院内病死率差异无统计学意义(P>0.05);不同休克类型患者间入院时左室射血分数、休克纠正时左室射血分数差异有统计学意义(P<0.05);不同休克类型患者间入院时下腔静脉直径差异有统计学意义(P<0.05),下腔静脉伴吸气塌陷率、1h后出现较多B线率差异无统计学意义(P>0.05)。结论: RUSH方案检测在评估休克患者心脏功能和容量反应性具有良好应用价值。

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关键词 ：休克, 休克患者快速超声评估流程, 心脏功能, 容量反应性

Abstract：Objective: To analyze the value of rapid ultrasound in shock (RUSH) on evaluating the cardiac function and volume responsiveness in patients with shock. Methods: One- hundred patients with shock in Department of Emergency and Critical Care Medicine of People’s Hospital of Ningxia Hui Autonomous Region from January 1, 2022 to January 31, 2024, were enrolled. RUSH regimen in identifying the type of shock was evaluated in diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate. The mechanical ventilation time, hospitalization time, in-hospital mortality, cardiac function (left ventricular ejection fraction [LVEF] on admission and shock correction) and volume responsiveness (inferior vena cava [IVC] diameter, inferior vena cava collapsibility index and more B-line rate after 1 hour of resuscitation) of different shock patients were analyzed. Results: The sensitivity, specificity and accuracy rate of RUSH regimen in 32 cases of cardiogenic shock were 91.67%, 98.68% and 97.00%, respectively; which in 33 cases of hypovolemic shock were 91.67%, 94.74% and 94.00%, respectively; which in 15 cases of obstructive shock were 95.00%, 97.50% and 97.00%, respectively; and which in 20 cases of distributive shock were 90.63%, 98.53% and 96.00%, respectively. There were statistically significant differences in mechanical ventilation time and hospitalization time among patients with different types of shock (P<0.05), but no significant difference was shown in in-hospital mortality (P>0.05). There were statistically significant differences in LVEF on admission and shock correction among patients with different types of shock (P<0.05). The IVC diameter on admission was statistically significant different among patients with different types of shock (P<0.05), but there were no statistically significant differences in IVC collapsibility index and more B-line rate after 1 hour of resuscitation (P>0.05). Conclusion: RUSH regimen has good application value on evaluating cardiac function and volume responsiveness in patients with shock.

Key words： Shock Rapid ultrasound in shock Cardiac function Volume responsiveness

基金资助:宁夏自然科学基金项目,(编号:2022AAC03393)

引用本文:

王蕊, 王芳, 赵洁, 刘晨晨, 孙广宏. 休克患者快速超声评估流程在评估心脏功能和容量反应性的价值[J]. 河北医学, 2025, 31(1): 122-127.
WANG Rui, WANG Fang, ZHAO Jie, et al. Value of Rapid Ultrasound in Shock on Evaluating Cardiac Function and Volume Responsiveness in Patients with Shock. HeBei Med, 2025, 31(1): 122-127.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.01.022 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I1/122

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