超声检测下腔静脉参数预测剖宫产术蛛网膜下腔阻滞后仰卧位低血压综合征的价值  

Value of ultrasonic inferior vena cava parameters in predicting cesarean section subarachnoid obstruction and supine hypotension syndrome

作　　者：王玥[1] 康凯[1] 李瑞萍 汪愫洁 Wang Yue;Kang Kai;Li Ruiping;Wang Sujie(Department of Anesthesiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院麻醉科,100026

出　　处：《中国医师杂志》2021年第12期1847-1850,共4页Journal of Chinese Physician

摘　　要：目的探讨超声检测下腔静脉参数预测蛛网膜下腔阻滞后仰卧位低血压综合征的价值。方法回顾性选择2019年8月至2020年3月首都医科大学附属北京妇产医院收治的单胎妊娠行蛛网膜下腔阻滞下剖宫产术者80例。按照是否发生麻醉后仰卧位低血压综合征分为两组(A组为发生仰卧位低血压综合征者,B组为未发生者),每组各40例。比较两组仰卧位时和左侧30°卧位时下腔静脉相关参数变化,分析下腔静脉呼气末最大直径(IVCe)、下腔静脉吸气末最小直径(IVCi)及下腔静脉塌陷指数(IVC-CI)与发生仰卧位低血压综合征时收缩压的相关性,比较IVCe、IVCi及IVC-CI预测仰卧位低血压综合征的价值。结果在仰卧位和左侧30°卧位时条件下,A组IVCe和IVCi水平均显著低于B组(P<0.05),IVC-CI高于B组(P<0.05),Spearman法分析发现IVCe及IVCi水平与发生仰卧位低血压综合征时收缩压呈正相关(P<0.05),IVC-CI与发生仰卧位低血压综合征时收缩压呈负相关(P<0.05),IVC-CI预测仰卧位低血压综合征发生的约登指数最高,且具有最高的灵敏度,IVCe预测仰卧位低血压综合征发生具有最高的特异度。结论IVC-CI对预测仰卧位低血压综合征有较高的灵敏度,IVCe对预测仰卧位低血压综合征的发生则具有较高的特异度。Objective To explore the clinical value of ultrasonic inferior vena cava parameters in predicting supine hypotension syndrome after subarachnoid block.Methods 80 cases of cesarean section under subarachnoid block in singleton pregnancy treated in Beijing Maternity Hospital from August 2019 to March 2020 were selected retrospectively.According to the occurrence of supine hypotension syndrome after anesthesia,they were divided into two groups(group A had supine hypotension syndrome and group B did not),with 40 cases in each group.The changes of related parameters of inferior vena cava in supine position and left 30°lying position were compared between the two groups.The correlation between the maximum end expiratory diameter(IVCe),the minimum end inspiratory diameter(IVCi)and the collapse index(IVC-CI)of inferior vena cava and the changes of systolic blood pressure in supine hypotension syndrome were analyzed,and the value of IVCe,IVCi and IVC-CI in predicting supine hypotension syndrome were compared.Results Under the condition of supine position and left 30°lying position,the levels of IVCe and IVCi in group A were significantly lower than those in group B(P<0.05),and the levels of IVC-CI were higher than those in group B(P<0.05).Spearman analysis showed that the levels of IVCe and IVCi were positively correlated with the changes of systolic blood pressure in the occurrence of supine hypotension syndrome(P<0.05),and the levels of IVC-CI were negatively correlated with the changes of systolic blood pressure in the occurrence of supine hypotension syndrome(P<0.05).IVC-CI had the highest yoden index and the highest sensitivity in predicting the occurrence of supine hypotension syndrome,and IVCe had the highest specificity in predicting the occurrence of supine hypotension syndrome.Conclusions Cava collapse index has high sensitivity to predict supine hypotension syndrome,while the maximum end-expiratory diameter of inferior vena cava has high specificity to predict supine hypotension syndrome.

关 键 词：超声检查 下腔静脉参数 蛛网膜下腔阻滞 仰卧位低血压综合征 

分 类 号：R719.8[医药卫生—妇产科学] R614[医药卫生—临床医学]