一种下腔静脉超声评估的图像采集方法
Summary
下腔静脉 （IVC） 的即时超声评估通常用于识别容量状态等。应系统地进行成像以确保可重复性。本手稿回顾了超声IVC检查的方法和缺陷。
Abstract
在过去的几十年里，临床医生已经将诊断即时超声（POCUS）的几种应用纳入了医疗决策。在 POCUS 的应用中，下腔静脉 （IVC） 成像被各种专业所采用，例如肾脏病学、急诊医学、内科、重症监护、麻醉学、肺病学和心脏病学。尽管每个专业使用IVC数据的方式略有不同，但大多数医学专业至少尝试使用IVC数据来预测血管内容量状态。虽然IVC超声检查数据与血管内容量状态之间的关系很复杂且高度依赖于上下文，但所有临床医生都应以标准化的方式收集超声检查数据，以确保可重复性。本文描述了标准化的IVC图像采集，包括患者定位，换能器选择，探头放置，图像优化以及IVC超声成像的缺陷和局限性。本文还描述了常见的IVC前位长轴位和IVC的其他三种视图，当前长轴位难以获得或解释时，每种视图都可以提供有用的诊断信息。
Introduction
在过去的几十年中，即时超声（POCUS）的可及性急剧增加。跨医学学科的提供者现在可以将 POCUS 整合到他们的床边检查中，并更容易地识别影响患者病情的重要因素1.例如，在急症护理环境中，最重要的重点领域之一是容量状态的评估和管理2。液体复苏不足可导致组织灌注不足、终末器官功能障碍和严重的酸碱异常。然而，过度热心的液体给药与死亡率恶化有关3。容量状态的确定主要通过体格检查结果和动态血流动力学测量相结合来完成，包括脉压变化、中心静脉压和/或通过被动抬腿试验或静脉推注液体激发4。随着POCUS设备的日益普及，一些供应商正在寻求使用超声成像来补充这些措施5。IVC前后维度的超声评估以及该维度的呼吸相变化有助于评估右心房压力，并可能评估血管内容量状态6，7，8，9。
然而，值得注意的是，IVC参数（即大小和呼吸相变化）与容量反应性之间的关系在许多常见情况下被扭曲，包括但不限于以下情况：（1）被动通气患者接受高呼气末正压（PEEP）或低潮气量;（2）自主呼吸的患者进行小呼吸或大呼吸努力;（3）肺过度充气;（4）损害静脉回流的疾病（如右心室功能不全、张力性气胸、心包填塞等）;（5）腹部腹压升高10.
虽然IVC超声检查作为评估血管内容量状态的独立措施的效用存在争议5，10，11，12，但对于将其用作诊断工具需要以标准化方式进行成像以及在单个有利位置证明不足时利用替代视图的能力这一事实没有争议2.为此，这份手稿定义了IVC的四种超声视图，说明了常见的超声缺陷以及如何避免它们，并提供了典型和极端IVC超声状态的示例。通过经腹超声检查可以充分观察IVC的四种视图：前短轴，前长轴，右外侧长轴和右外侧短轴。下面的协议描述了一种标准化的图像采集方法。
Protocol
在涉及人类参与者的研究中执行的所有程序均按照杜克大学卫生系统机构研究委员会的道德标准和1964年赫尔辛基宣言及其后来的修正案或类似的道德标准进行。该协议是使用学术文献2，13，14，15中的几篇同行评审论文的输入进行的。对正常图像的作者本身进行了成像，并作为常规教育超声扫描的一?…
Representative Results
充分的检查IVC没有单一的口径或呼吸相行为，可以在所有情况下都被认为是普遍正常的。例如，视频1-4和图3中看到的IVC是在健康，水合的男性身上成像的，没有急性疾病。然而，值得注意的是，该患者的“正常”IVC具有相对较大的AP直径，在ANTIVC LAX视图中为>2厘米，并且显示最小的呼吸相变化。在其他情况下，这种完全?…
Discussion
即使成像正确，从IVC获得的信息也不应成为用于指导治疗的唯一数据点。在正常状态和病理条件下都可以看到完全相同的IVC大小和呼吸变化。因此，临床环境对于指导如何解释IVC数据至关重要。此外，当使用超声评估患者的血管内容量状态时，关于IVC大小和呼吸变化的阈值准确预测了随后的心输出量增加以响应血管内容量挑战（即容量反应性）5，11，<sup class="x…
Disclosures
The authors have nothing to disclose.
Acknowledgements
作者没有承认。
Materials
| Edge 1 ultrasound machine | SonoSite | n/a | Used to obtain all adequate and inadequate images/clips |
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Cite This Article
Hoffman, M., Convissar, D. L., Meng, M., Montgomery, S., Bronshteyn, Y. S. Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava. J. Vis. Exp. (191), e64790, doi:10.3791/64790 (2023).