血管紧张素Ⅱ对慢性深部胸骨感染患者清创术中低血压的预警作用  

The early warning effects of angiotensinⅡfor hypotension during debridement surgery in patients with deep sternal infection

作　　者：姚欢杰 王凯璇 崔振田 陆龙 郭文治 YAO Huanjie;WANG Kaixuan;CUI Zhentian(Anesthesiology College of Shanxi Medical University,Shanxi,Taiyuan 030000,China;不详)

机构地区：[1]山西医科大学麻醉学院,太原市030000 [2]中国人民解放军总医院第六医学中心心血管外科 [3]中国人民解放军总医院第七医学中心麻醉科

出　　处：《河北医药》2021年第20期3096-3099,共4页Hebei Medical Journal

基　　金：中国人民解放军总医院第七医学中心青年培育基金。

摘　　要：目的探讨术前血管紧张素Ⅱ(ATⅡ)水平能否作为慢性深部胸骨感染患者麻醉后发生血管扩张性休克的预警指标。方法选取2019年7月至2021年2月行胸壁病损清除术患者21例,年龄≥18岁,ASA≤Ⅲ级,心功能≤3级,记录患者术前、术中基本情况以及术中不同时间点的MAP、CO、SVV,抽取术前、术中、术后不同时间点的静脉血测定ATⅡ值;记录术中、术后的不良事件。根据术中血压情况将患者分为低血压组(A组)和对照组(B组),将组间比较有意义的术前指标纳入二元Logistic回归分析术中低血压的危险因素,采用受试者工作特征(ROC)曲线分析ATⅡ值对低血压的预测价值。结果A组患者术前、术中的ATⅡ值均高于B组(P<0.05),术后两者差异无统计学意义(P>0.05);与同组术前ATⅡ值相比,A组患者术中、术后ATⅡ值均下降(P<0.05),B组患者术中ATⅡ值下降(P<0.05),术后ATⅡ值与术前差异无统计学意义(P>0.05)。二元Logistic回归分析显示:术前ATⅡ值、感染时间不是术中低血压的危险因素(P>0.05)。ROC曲线分析显示:术前ATⅡ值为57.6 pg/ml时,约登指数最大,其敏感性为100%,特异性为66.7%,AUC曲线下面积为0.827,诊断有一定的准确性。结论术前ATⅡ值高的胸骨感染患者行胸壁病损清除术全麻后更容易出现低血压,cut-off值大约为57.6 pg/ml。但仍需更大的样本量来证实。Objective To investigate the early warning effects of angiotensinⅡlevels detection for the occurrence of vasodilation shock in patients with chronic deep sternal infection(DTI)after anesthesia.Methods A total of 21 patients with DTI who underwent debridement in our hospital from July 2019 to February 2021 were enrolled in the study,with age≥18 years old,ASA≤gradeⅢ,cardiac function≤grade 3.The general condition,the MAP,CO,SVV at different time points during the operation,and serum levels ATⅡbefore operation,during operation and after operation were detected.According to the intraoperative blood pressure,the patients were divided into hypotension group(group A)and control group(group B).The significant preoperative indexes were observed and compared between the two.Moreover the ROC curve of subjects’working characteristics was used to analyze the predictive value of ATⅡvalue in hypotension.Results The levels ATⅡbefore operation,during operation in group A were significantly higher than those in group B(P<0.05),however,there were no significant differences after operation between the two groups(P>0.05).Compared with the those before operation,the ATⅡlevels during operation and after operation in group A were significantly decreased(P<0.05),which after operation in group B were significantly decreased(P<0.05),but there were no significant differences in group B before and after operation(P>0.05).The results of binary Logistic regression analysis showed that preoperative ATII levels and infection time were not the risk factors for intraoperative hypotension.ROC curve analysis showed that when the preoperative ATⅡlevels were 57.6pg/ml,the Jordan index was the greatest,with sensitivity and specificity being 100%,66.7%,respectively.The area under the AUC curve was 0.827,indicating a certain accuracy of diagnosis.Conclusion The DTI patients with higher ATⅡlevels febore operation are easy to suffer from hypotension after debridement surgery,with cut-off being about 57.6pg/ml,but,which need to be ide

关 键 词：血管紧张素Ⅱ 休克 血管扩张性休克 胸骨感染 

分 类 号：R681.2[医药卫生—骨科学]