超声观察下腔静脉塌陷预测椎管内麻醉后低血压

目的评价超声观察下腔静脉塌陷预测椎管内麻醉后低血压的价值。方法纳入299例接受椎管内麻醉下择期手术患者,根据麻醉后是否出现低血压分为低血压组(n=41)与非低血压组(n=258),比较2组进入手术室后5 min(T1)和麻醉后5 min(T2)、10 min(T3)、15 min(T4)、20 min(T5)、25 min(T6)及30 min(T7)收缩压、舒张压、平均动脉压(MAP)和心率;记录T1、T3、T5及T7各时间点超声所测下腔静脉呼气末最大直径(IVCe)及吸气末最小直径(IVCi),计算下腔静脉塌陷指数(CI)。以Pearson相关性分析观察CI与血压的相关性;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价CI预测椎管内麻醉后出现低血压的价值。结果椎管内麻醉后低血压发生率为13.71%(41/299)。低血压组T3时收缩压、舒张压及MAP均明显低于非低血压组(P均0.05)。低血压组内T3时低收缩压、舒张压、MAP、心率均明显低于T1(P均0.05);非低血压组T3时MAP、心率均明显低于T1(P均0.05)。低血压组T1、T3时IVCe及IVCi均明显小于非低血压组(P均0.05)、CI均高于非低血压组(P均0.05);T3时IVCe及IVCi均明显低于T1(P均0.05),CI则较T1明显升高(P0.05)。2组T3时CI均与收缩压、舒张压及MAP呈负相关(r=-0.437、-0.361、-0.315,P均0.01)。CI预测椎管内麻醉后低血压的AUC为0.864,截断值取43.26%时,敏感度为75.60%,特异度为84.90%。结论超声测量下腔静脉CI预测椎管内麻醉后低血压的效能较好。

Ultrasound observation on inferior vena cava collapse for predicting hypotension after intraspinal anesthesia

Objective To observe the value of ultrasound observation on inferior vena cava collapse for predicting hypotension after intraspinal anesthesia. Methods A total of 299 patients scheduled for elective surgery under intraspinal anesthesia were included and divided into hypotension group (n=41) or non-hypotension group (n=258) according to whether hypotension occurred after anesthesia. The systolic blood pressure, diastolic blood pressure, the mean arterial pressure (MAP) and heart rate 5 min after entering the operating room (T1), 5 min (T2), 10 min (T3), 15 min (T4), 20 min (T5), 25 min (T6) and 30 min (T7) after anesthesia were recorded and compared between groups. Ultrasonic measurement values of inferior vena cava end expiratory maximal diameter (IVCe) and inferior vena cava end inspiration minimum diameter (IVCi) were recorded at T1, T3, T5 and T7, and the inferior vena cava collapse index (CI) was calculated. The correlation between CI and blood pressure was analyzed with Pearson correlation. Receiver operating characteristic (ROC) curves were drawn to calculate the area under the curve (AUC) and analyze the value of CI for predicting hypotension after intraspinal anesthesia. Results The incidence rate of hypotension after intraspinal anesthesia was 13.71% (41/299). The systolic blood pressure, diastolic blood pressure and MAP in hypotension group at T3 were all lower than those in non-hypotension group (all P<0.05). In hypotension group, the systolic blood pressure, diastolic blood pressure, MAP and heart rate at T3 were all lower than those at T1 (all P<0.05). In non-hypotension group, MAP and heart rate at T3 were all lower than those at T1 (both P<0.05). IVCe and IVCi at T1 and T3 in hypotension group were significantly lower but CI was significantly higher than those in non-hypotension group (all P<0.05), while IVCe and IVCi at T3 were smaller than those at T1 in hypotension group (both P<0.05). CI of T3 was negatively correlated with systolic blood pressure, diastolic blood pressure and MAP (r=-0.437, -0.361, -0.315; all P<0.01) in both groups. The AUC of CI for predicting hypotension after intraspinal anesthesia was 0.864. Taken 43.26% as the cut-off value, the sensitivity was 75.60%, and the specificity was 84.90%. Conclusion Ultrasound observation of inferior vena cava collapse had good efficacy on predicting hypotension after intraspinal anesthesia.