肥胖患者椎管内麻醉后低血压的危险因素及预测的有效性  

Analysis of risk factors and obesity related indicators of hypotension after spinal anesthesia in obese patients

作　　者：张庆桐 徐锋 殷姜文 葛明月 李燕[1] 谢丽萍[1] 王兴松 王胜[2] ZHANG Qingtong;XU Feng;YIN Jiangwen;GE Mingyue;LI Yan;XIE Liping;WANG Xingsong;WANG Sheng(Department of Anesthesiology,the First Affiliated Hospital,School of Medicine,Shihezi University,Shihezi 832002,China)

机构地区：[1]新疆石河子大学医学院第一附属医院麻醉科,832002 [2]中国科学技术大学第一附属医院麻醉科 [3]安徽省寿县中医医院

出　　处：《临床麻醉学杂志》2020年第5期441-444,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨肥胖患者椎管内麻醉后发生低血压的危险因素,评估肥胖相关指标预测椎管内麻醉后低血压的效果。方法选取2018年6月至2019年6月在本院择期行椎管内麻醉手术肥胖患者228例,男115例,女113例,年龄18~70岁,BMI≥24 kg/m^2,ASAⅠ或Ⅱ级。根据患者椎管内麻醉后仰卧位10 min内是否发生低血压分为两组:低血压组和非低血压组,低血压定义为MAP下降幅度超过基线值的20%。采用二元logistic回归分析肥胖患者椎管内麻醉后发生低血压的危险因素,并用受试者工作特征曲线(ROC)计算肥胖相关测量指标对椎管内麻醉后低血压的预测效果及阈值。结果共有97例(42.5%)患者椎管内麻醉后发生低血压。其中血脂异常(OR=3.593,95%CI 1.974~6.541)和腹型肥胖(OR=1.980,95%CI 1.068~3.668)是肥胖患者椎管内麻醉后发生低血压的独立危险因素。在肥胖相关测量指标中,腰围对肥胖患者椎管内麻醉后低血压的预测效果最优,男性患者阈值为87.5 cm,敏感性92.9%,特异性81.4%。女性患者阈值为83.5 cm,敏感性89.6%,特异性93.8%。结论术前重视肥胖患者的血脂及腰围可以有助于预测椎管内麻醉后低血压。Objective To explore the risk factors of hypotension after spinal anesthesia in obese patients and to evaluate the result of obesity related indexes to predict hypotension after spinal anesthesia.Methods A total of 228 patients undergoing general and orthopedic surgery from June 2018 to June 2019,115 males and 113 females,aged 18-65 years,with a BMI≥24 kg/m 2,falling into ASA physical statusⅠorⅡ,were analyzed in this study.The patients were divided into two groups according to whether hypotension occurred within 10 minutes of supine position after spinal anesthesia,hypotension group and non-hypotension group.Hypotension was defined as a decrease in mean arterial pressure of more than 20%of the baseline value.Binary logistic regression was used to analyze the risk factors of hypotension after intravertebral anesthesia in obese patients,and receiver operating characteristic curve(ROC)was used to compare the effect of obesity related indicators to predict hypotension after intravertebral anesthesia.Results A total of 97 patients(42.5%)had hypotension after spinal anesthesia.Dyslipidemia(OR=3.593,95%CI 1.974-6.541)and abdominal obesity(OR=1.980,95%CI 1.068-3.668)were independent risk factors for hypotension after spinal anesthesia in obese patients.Among the obesity-related indicators,waist circumference was the most sensitive indicator to predict hypotension after spinal anesthesia in obese patients,with the optimal cut-off point of 87.5 in males and 83.5 in females.Conclusion Preoperative attention to the blood lipids and waist circumference of obese patients is helpful to predict hypotension after spinal anesthesia.

关 键 词：肥胖 椎管内麻醉 低血压 血脂异常 

分 类 号：R614[医药卫生—麻醉学]