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下腔静脉扩张指数评估机械通气患者容量反应性价值的Meta分析 预览

Meta-analysis of the Value of Inferior Vena Caval Expansion Index in Evaluating the Volume Reactivity of Mechanical Ventilation Patients
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摘要 目的搜集现有文献证据,对下腔静脉扩张指数对机械通气状态下患者容量反应状态的诊断价值进行系统评价。方法全面检索中国知网全文数据库,Pubmed,Embase,the Cochrane datebase数据库,检索时限为建库至2018年10月。纳入符合要求的评估下腔静脉扩张指数对机械通气状态下,患者容量反应状态诊断价值的临床对照试验,根据I2确认各研究间的异质性,I2>50%采用随机效应模型分析,I2<50%采用固定效应模型分析,计算合并灵敏度,特异度,诊断比值比(95%CI),绘制受试者工作曲线,计算曲线下面积,根据PEEP的有无进行亚组分析,以探究异质性的来源。使用Quadas-2进行质量评估。结果研究共纳入13篇文献,QUDAS-2量表评估各文献质量均较高,其中包括992例受试者。Meta分析显示合并灵敏度,特异度,诊断比值比分别为0.66(95%CI:0.62~0.70),0.80(95%CI:0.77~0.84),19.72(95%CI:7.07~54.94),合并AUROC为0.8825。各研究间异质性均较大(I2>50%,P<0.05)。结论下腔静脉扩张指数对于机械通气状态下患者容量反应状态具有较高诊断价值,机械通气时给予呼气末正压会导致下腔静脉扩张指数评估容量反应性的敏感度和特异度下降。 Objective To collect the existing literature evidence and systematically evaluate the diagnostic value of the inferior vena cava expansion index for the patient's volume response status under mechanical ventilation. Methods A comprehensive search of the China Knowledge Network full-text database, Pubmed, Embase, the Cochrane datebase database, the search time limit for the construction of the library until October 2018. A clinical controlled trial evaluating the diagnostic value of the inferior vena cava dilatation index to the patient's volume response status under mechanical ventilation was included. The heterogeneity between the studies was confirmed according to I2. I2>50% was analyzed by random effects model, I2<50% using fixed-effects model analysis, calculating combined sensitivity, specificity, diagnostic odds ratio (95%CI), plotting the receiver's working curve, calculating the area under the curve, and performing subgroup analysis based on the presence or absence of PEEP to explore heterogeneity Source of sex. Using the Quadas-2 to conduct the quality assessment. Results A total of 13 articles were included in the study. The QUADBS-2 scale assessed the quality of each document, including 992 subjects. Meta-analysis showed that the combined sensitivity, specificity, and diagnostic odds ratio were 0.66 (95%CI: 0.62 to 0.70), 0.80 (95%CI: 0.77 to 0.84), and 19.72 (95%CI: 7.07 to 54.94), combined with AUROC. 0.8825. Heterogeneity was greater among studies (I2>50%, P<0.05). Conclusion The inferior vena cava dilatation index has a high diagnostic value for the patient's volume response state under mechanical ventilation. The positive end expiratory pressure during mechanical ventilation leads to a decrease in the sensitivity and specificity of the inferior vena cava dilatation index for assessing volume reactivity.
作者 陈伟 王鸿志 陈永权 CHEN Wei;WANG Hong-zhi;CHEN Yong-quan(Department of Anesthesiology,the First Affiliated Yijishan Hospital,Wannan Medical College,Wuhu 241000,Anhui,China)
出处 《医学信息》 2019年第12期80-84,共5页 Medical Information
关键词 下腔静脉扩张指数 机械通气 容量反应性 Inferior vena cava dilatation index Mechanical ventilation Volume reactivity
作者简介 陈伟(1988.11-),女,安徽池州人,硕士研究生,住院医师,主要从事麻醉与应激方向研究;通讯作者:陈永权(1967.12-),男,安徽芜湖人,硕士,主任医师,科主任,主要从事麻醉与应激方向研究.
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