超声下腔静脉呼吸变异指数对骨科手术患者腰椎麻醉后低血压的预测价值  

Predictive value of ultrasound inferior vena cava respiratory variation index for hypotension after spinal anesthesia in orthopedic patients

作　　者：柳洁 王莹莹[1] 刘莉[1] 吕瑞兆 白晓明 井郁陌[1] LIU Jie;WANG Yingying;LIU Li;LYU Ruizhao;BAI Xiaoming;JING Yumo(the First Ward of Department of Anesthesiology,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou,Hebei 061001,China)

机构地区：[1]河北省沧州中西医结合医院麻醉一科,061001

出　　处：《重庆医学》2021年第2期224-228,共5页Chongqing medicine

基　　金：河北省卫生健康委员会2019年度科研立项(20191278)。

摘　　要：目的探讨超声下腔静脉呼吸变异指数(IVC-RVI)对骨科手术患者腰椎麻醉后发生低血压的预测价值。方法选取2019年1—12月于该院行择期骨科手术的患者194例,所有患者麻醉方法均为腰椎麻醉。术前使用超声对IVC-RVI相关超声指标进行测量,患者麻醉完成后常规监测生命体征。记录麻醉完成至手术结束时发生低血压的患者,分析导致患者术中发生低血压的影响因素,同时分析IVC-RVI对患者麻醉后发生低血压的预测价值。结果根据术中低血压发生标准,腰椎麻醉后共60例患者发生低血压,发生率为30.93%。术中低血压患者术前促血管收缩性药物使用率明显低于血压正常患者,术前高血压患病率及IVC-RVI明显高于血压正常患者(P<0.05)。术前促血管收缩药物使用为术中低血压发生的保护因素(OR=0.335,P=0.014),术前高血压(OR=3.614,P=0.002)及IVC-RVI(OR=1.468,P<0.001)是术中低血压发生的危险因素。IVC-RVI预测腰椎麻醉后低血压的受试者工作特征(ROC)曲线下面积为0.850(95%CI:0.790~0.909,P<0.001),截断值为35.87%,灵敏度为88.3%,特异度为74.42%。结论IVC-RVI对腰椎麻醉后患者低血压的发生具有较好的预测价值,可用于指导腰椎麻醉患者术后低血压的预防性治疗。Objective To investigate the predictive value of ultrasound inferior vena cava variability index(IVC-RVI)for hypotension after spinal anesthesia in orthopedic patients.Methods A total of 194 patients who underwent elective orthopedic surgery in our hospital from January 2019 to December 2019 were selected.All patients were treated with spinal anesthesia.Ultrasound was used to measure IVC-RVI-related ultrasound indicators before surgery,and patients were routinely monitored for vital signs after anesthesia was completed.The patients developed hypotension from anesthesia completion to the end of surgery were counted,and then the risk factors leading to hypotension during surgery were analyzed,and the predictive value of IVC-RVI on the occurrence of hypotension after anesthesia was analyzed.Results According to the intraoperative hypotension standard,a total of 60 patients developed hypotension after spinal anesthesia,the incidence rate was 30.93%.The preoperative use rate of vasoconstrictor drugs in patients with hypotension during surgery was significantly lower than that in normal patients,while the rate of hypertension and IVC-RVI were significantly higher(P<0.05).Preoperative use of vasoconstriction drugs was protective factor for hypotension during operation(OR=0.335,P=0.014).Hypertension before surgery(OR=3.614,P=0.002),and IVC-RVI(OR=1.468,P<0.001)are risk factors for hypotension during surgery.The area under receiver operating characteristic(ROC)curve of IVC-RVI for predicting hypotension after spinal anesthesia was 0.850(95%CI:0.790-0.909,P<0.001),the cut-off value was 35.87%,the prediction sensitivity was 88.3%,and the specificity was 74.42%.Conclusion IVC-RVI has a good predictability for the occurrence of hypotension in patients with spinal anesthesia,and it can clinically guide the preventive treatment of postoperative hypotension after spinal anesthesia.

关 键 词：蛛网膜下腔麻醉 低血压 超声 下腔静脉变异度 预测 

分 类 号：R614[医药卫生—麻醉学]