超声测量产妇仰卧位右股静脉横径对剖宫产腰麻后低血压的预测价值  

The Transverse Diameter of Right Femoral Vein by Ultrasound in Supine Position for Predicting Post-spinal Hypotension During Cesarean Delivery

作　　者：马瑞 徐韬[1] 王坚伟[1] 卫宇[1] MA Rui;XU Tao;WANG Jian-wei;WEI Yu(Department of Anesthesiology,the International Peace Maternity and Child Health Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai Key Laboratory of Embryo Original Diseases,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院麻醉科,上海市胚胎源性疾病重点实验室,上海200030

出　　处：《中国现代手术学杂志》2021年第3期205-211,共7页Chinese Journal of Modern Operative Surgery

基　　金：上海市卫生和计划生育委员会科研课题资助项目(20164Y0263)。

摘　　要：目的评估超声测量腹主动脉、下腔静脉、右股动脉和右股静脉的峰值流速和直径在反映产妇子宫对腹主动脉和下腔静脉压迫中的意义,并进一步预测产妇腰麻后低血压发生的可能性。方法共有56例腰麻下行择期剖宫产的产妇纳入本次前瞻性随机研究,麻醉前运用超声测量腹主动脉、下腔静脉、右股动脉、右股静脉的峰值流速及直径。腰麻后低血压定义为麻醉后收缩压下降超过基础收缩压的20%。主要观察指标为B超测量的血管参数,以及腰麻后低血压的发生情况。采用多元Logistic回归计算剖宫产腰麻后低血压的危险因素,再用ROC曲线计算曲线下面积和最优预测临界值。结果右股静脉横径为腰麻后低血压的危险因素(OR=2.022,95%CI 1.261~3.243),其ROC曲线下面积为0.759(0.628~0.890,P=0.001),右股静脉横径大于12.2 mm可预测剖宫产术中腰麻后低血压的发生,其余B超测量参数均与剖宫产腰麻后低血压无明显相关性。结论产妇右股静脉横径与剖宫产腰麻后低血压相关,并能预测产妇剖宫产术中腰麻后低血压的发生。Objective To assess whether peak velocities and diameters of abdominal aorta,inferior vena cava,right femoral artery and right femoral vein,as measured on ultrasound,could reflect the degree of aortocaval compression and further identify parturients at risk of post-spinal hypotension.Methods 56 parturients undergoing elective cesarean section with spinal anesthesia were enrolled in this prospective rondomized study.Ultrasound measurement of peak velocities and diameters of abdominal aorta,inferior vena cava,right femoral artery and right femoral vein before anesthesia was performed in these parturients.Hypotension was defined as a drop in SAP by>20%from the baseline value before delivery.The primary outcomes were the measurements of the vessels by ultrasound before anesthesia and the accureance of post-spinal hypotension.Multinomial Logistic regression analysis was used to identify the risk factors for post-spinal hypotension during cesarean delivery.Receiver operating characteristic curves were used to calculate the areas under the curve and the optimum cut-off values to identified the abilities of parameters to predict post-spinal hypotension.Results The transverse diameter of the right femoral vein was associated to post-spinal hypotension(OR=2.022,95%CI 1.261~3.243).The area under the receiver operating characteristics curve for the prediction of post-spinal hypotension was 0.759(0.628~0.890,P=0.001).The transverse diameter of the RCFV longer than 12.2 mm could well predict post-spinal hypotension during cesarean delivery.There was no significant correlation between the other B-mode ultrasonography parameters and hypotension after caesarean section.Conclusion A higher transverse RCFV diameter is associated with post-spinal hypotension of parturients during Cesarean delivery and it could effectively predict the risk of post-spinal hypotension before anesthesia.

关 键 词：右股静脉 横径 低血压 剖宫产 超声 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]