Study On The Value Of Ultrasound In Predicting The Fluid Responsiveness Of Traumatic Patients Under Spontaneous Breathing

Objective:To study the value of variation in five ultrasonic measurement indexs[internal jugular vein variation??IJV??carotid artery peak velocity variation??COPV??brachial artery peak velocity variation??Vpeak??inferior vena cava variation??IVC??velocity time index variation??VTI?]in predicting fluid responsiveness of traumatic patients under spontaneous breathing and compare sensitivity and specificity of each index after passive leg raising test?a mini-fluid challenge.Provide the best index for predicting fluid responsiveness of traumatic patients under spontaneous breathing and guide early fluid treatmentMethod:Approved by ethic committee of the 940th Hospital of the Joint Logistics Support Force of Chinese People's Liberation Army.38 cases traumatic patients that signed the informed consent with the patients and their families of the people's the 940th Hospital Of the Joint Logistics Support Force of Chinese People's Liberation Army were selected in April 2018^January 2019,the heart rate?HR?,mean arterial pressure?MAP?,central venous pressure?CVP?,and five ultrasonic measurement indexes and calculating the respiration variation of each indicator:internal jugular vein variation??IJV??carotid artery peak velocity variation??COPV??brachial artery peak velocity variation??Vpeak??inferior vena cava variation??IVC??velocity time index variation??VTI?were recorded at baseline and after passive leg raising test?a mini-fluid challenge.CI and?CI were recorded and calculated after volume load test?500 ml compound sodium chloride injection over 15min?.?CI[?CI=CI₅₀₀-CI₀/CI₀)×100%]?15%was defined as responsiveness group,and?CI<15%was defined as non-responsiveness group.The receiver operating characteristic curve was used to evaluate the value and compare the sensitivity and specificity of?IJV₁₀₀??COPV₁₀₀??Vpeak₁₀₀??IVC₁₀₀??VTI₁₀₀??IJV_PLRT??COPV_PLRT??Vpeak _PLRT??IVC_PLRTand?VTI_PLRTLRT in predicting fluid responsiveness of traumatic patients under spontaneous breathing.Result:There were 25 cases in the responsiveness group,13 cases in the non-responsiveness group;Compared with non-responsiveness group,?COPV??Vpeak??VTI were increased in responsiveness group at the T₀ time?P<0.05?.And the area under the operating characteristic curve of?IJV₁₀₀??COPV₁₀₀??Vpeak₁₀₀??IVC₁₀₀??VTI₁₀₀??IJV_PLRT??COPV_PLRT??Vpeak_PLRT??IVC_PLRT??VTI_PLRTLRT at the T₁₀₀?T_PLRTtime were:0.574?0.870?0.899?0.689?0.824?0.747?0.865?0.971?0.690?0.968.Among them,the area under the operating characteristic curve of?COPV₁₀₀??Vpeak₁₀₀??COPV_PLRT??Vpeak_PLRTLRT and?VTI_PLRTLRT was higher,But the correlation between?Vpeak_PLRT?VTI_PLRTLRT and?CI was better,?Vpeak_PLRT?r=0.892?P=0.000???VTI_PLRT?r=0.783?P=0.000?.?Vpeak _PLRT?8.55%predicted fluid responsiveness with a sensitivity and specificity of 86.4%and 92.1%,respectively;?VTI_PLRT?8.35%predicted fluid responsiveness with a sensitivity and specificity of 84.6%and 91.7%,respectively.Conclusion:The values of?IJV??IVC??COPV??Vpeak and?VTI?AUC:0.365?0.340?0.000?0.029?0.250?predicting fluid responsiveness of traumatic patients under spontaneous breathing were low.the value of variation of five ultrasonic measurement indexs significantly improved in predicting fluid responsiveness of traumatic patients under spontaneous breathing after a mini-fluid challenge test and passive leg raising test,but the variation of ultrasonic measurement indexs after passive leg raising test were more significant than after a mini-fluid challenge test.?Vpeak_PLRTLRT accurately predicts fluid responsiveness of traumatic patients under spontaneous breathing?AUC:0.971;r=0.892?,?Vpeak_PLRT?8.55%predicted fluid responsiveness with a sensitivity and specificity of 86.4%and 92.1%,respectively.