目的 利用超声成像定位颈内静脉塌陷点,依据血流静力学原理无创测定中心静脉压.方法 纳入40例患者,利用浅表超声探头对右侧颈内静脉塌陷段顶点定位及标记,另于右胸侧壁标记右房的体表投影,根据二者垂直高度计算中心静脉压;对患者行中心静脉导管测压.对两种方法测压结果进行相关分析;以中心静脉导管测压为金标准,绘制超声法诊断中心静脉压升高的ROC曲线,找出最佳截点.结果 超声定位法测压与中心静脉导管测压结果高度相关,Pearson相关系数r=0.906,P＜0.01;经ROC曲线检验,以超声法测定液柱高度10.75 cm为截断点诊断中心静脉压升高的敏感性为88.9％,特异性为93.5％,ROC曲线下面积为0.971.结论 超声法可无创测得患者中心静脉压,对判断患者循环负荷情况有较高价值.%Objective To determine the central venous pressure (CVP) noninvasively based on hemodynamics principles using ultrasound location of the collapse point of the internal jugular vein.Methods Forty patients were enrolled in this study.The collapse point of the internal jugular vein was located and marked by a linear transducer,the body mark of right atrium was marked on the right lateral wall of the chest.The noninvasive CVP was calculated according to the vertical distance between those two points.The invasive CVP determination by central venous catheter was also carried out on all the patients.Correlation analysis was used to compare the invasive and noninvasive methods.With invasive determination of CVP as the gold standard,the ROC curve of the noninvasive ultrasound method was sketched to explore the optimal cut-off points.Results The correlation analysis reveal high positive correlation between CVPs determined by ultrasound imaging and central venous catheter (r =0.906,P ＜0.01).By the ROC curve test,fluid column height of 10.75 cm by ultrasound method was determined as the cut-off point,with the sensitivity and specificity of diagnosing elevation of CVP being 88.9％ and 93.5 ％ respectively.The corresponding area under the curve was 0.971.Conclusions Ultrasound imaging could be used to determine CVP noninvasively,which would be helpful in diagnosis of the circulating load of patients.
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