下腔静脉塌陷指数对老年患者腰麻后低血压的预测价值  

The predictive effect of inferior vena cava collapsibility index on postspinal anesthesia hypotension in elderly patients

作　　者：张钰 樊世文 殷姜文 翟晶雯 葛明月 秦新磊 代志刚[1] ZHANG Yu;FAN Shi-wen;YIN Jiang-wen;ZHAI Jing-wen;GE Ming-yue;QIN Xin-lei;DAI Zhi-gang(Department of Anesthesiology,the First Affiliated Hospital of Medical College of Shihezi University,Shihezi 832000,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,832000

出　　处：《天津医药》2021年第2期179-184,共6页Tianjin Medical Journal

摘　　要：目的探讨下腔静脉塌陷指数(IVC-CI)对老年患者腰麻后低血压(PSAH)的预测价值以及术前合并高血压病是否影响IVC-CI对PSAH的预测。方法选择择期行腰麻(SA)下手术的老年患者163例,根据术前是否临床确诊高血压病分为合并高血压病组(H组)和未合并高血压病组(N组),2组再根据腰麻后30 min内是否发生低血压分为低血压组(D组)和未发生低血压组(F组)。分别在SA前、SA后超声测量腔静脉直径(dIVC)最大值(dIVCmax)和IVC-CI。记录SA前和SA后30 min内收缩压(SBP)、平均动脉压(MAP)、心率(HR)。结果49例(30.1%)发生PSAH。H组患者年龄、体质量指数(BMI)、腰围、SBP、MAP、HR基线值、PSAH发生率明显高于N组患者(P<0.05)。D组SA前、后IVC-CI均明显大于F组(P<0.01)。N组SA前、后IVC-CI与SA后30 min内最低SBP和MAP呈负相关(P<0.01)。H组SA前、后IVC-CI与SA后30 min内最低SBP和MAP呈负相关(P<0.01)。SA前和SA后IVC-CI预测PSAH的ROC曲线下面积(AUC)明显大于SA前、后dIVCmax(P<0.01)。结论SA前和SA后IVC-CI均可以预测术前合并、未合并高血压病老年患者PSAH的发生,可作为一种无创的预测老年患者PSAH的方法。Objective To investigate the predictive effect of ultrasound measurement of inferior vena cava collapsibility index(IVC-CI)on postspinal anesthesia hypotension(PSAH)in elderly patients and whether preoperative hypertension affects IVC-CI predictive value of PS AH.Methods A total of 163 elderly patients undergoing elective surgery under spinal anesthesia(SA)were enrolled in this study.According to the preoperative diagnosis of hypertension,patients were divided into patients with hypertension group(H group)and patients without hypertension group(N group).Then according to the occurrence of PS AH during 30 min after SA,the two group were subdivided into hypotension group(D group)and non-hypotension group(F group).The maximum inferior vena cava diameters(dIVCmax)and IVC-CI were measured before and after SA.The systolic blood pressure(SBP),mean arterial pressure(MAP),and heart rate(HR)were recorded before SA and 30 min after SA.Results There were 49 patients(30.1%)had hypotension after SA.The baseline values of age,body mass index(BMI),waist circumference,incidence of PSAH,SBP,MAP and HR were significantly higher in group H than those in group N(P<0.05).Before SA and after SA,dIVCmax,was significantly smaller in group D than that of group F(P<0.05).Before SA and after SA,IVC-CI was significantly greater in group D than that of group F(P<0.01).Before SA and 30 min after SA,IVC-CI was negatively correlated with the lowest SBP and MAP in N group(P<0.01).In H group,before SA and 30 min after SA,IVC-CI was negatively correlated with the lowest SBP and MAP(P<0.01).Before and after SA,the area under ROC curve(AUC)of PS AH predicted by IVC-CI was significantly larger than that of dIVCmax(P<0.01).Conclusion Before and after spinal anaethesia,IVC-CI can predict the occurrence of PSAH of the elderly patients with hypertension,and which can be used as a noninvasive method for predicting PS AH in the elderly patients.

关 键 词：腔静脉 下 低血压 麻醉 脊椎 ROC曲线 下腔静脉塌陷指数 老年患者 

分 类 号：R614[医药卫生—麻醉学]