基于下腔静脉塌陷指数导向补液预防骨科手术患者蛛网膜下腔阻滞麻醉后低血压的研究  

Study of guiding fluid infusion based inferior vena cava collapsibility index on prevention hypotension after subarachnoid block anesthesia in orthopedic surgery patients

作　　者：刘莉[1] 王莹莹[1] 吕瑞兆 柳洁 张慧娟 井郁陌[1] Liu Li;Wang Yingying;Lyu Ruizhao;Liu Jie;Zhang Huijuan;Jing Yumo(Department of Anesthesia and Perioperative Medicine,Cangzhou Hospital of Integrated Traditional and Western Medicine in Hebei Province,Hebei Cangzhou 061000,China)

机构地区：[1]河北省沧州中西医结合医院麻醉与围手术期医学科,河北沧州061000

出　　处：《中国医刊》2023年第3期316-320,共5页Chinese Journal of Medicine

基　　金：河北省医学科学研究课题计划(20191278)。

摘　　要：目的探讨基于下腔静脉塌陷指数(inferior vena cava collapsibility index,IVC-CI)的导向补液策略对骨科手术患者蛛网膜下腔阻滞麻醉后低血压的预防效果。方法选取2019年6月至2021年6月河北省沧州中西医结合医院收治的拟行骨科手术的196例患者为研究对象,采用随机数字表法分为试验组和对照组,每组98例。对照组给予常规输液管理,试验组给予以IVC-CI36%为阈值的导向补液。比较分析两组患者进入手术室时(T0)、麻醉即刻(T1)、麻醉后5min(T2)、麻醉后10min(T3)的平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)、心输出量(cardiac output,CO)和每搏输出量变异度(stroke volume variation,SVV)。比较分析两组患者麻醉后的总补液量、低血压发生情况以及血管活性药物使用情况。结果与T0、T1时刻比较,两组患者T2、T3时刻的MAP、HR、CO均显著降低(P<0.05)。T0、T1时刻,两组患者的MAP、HR、CO比较差异均无显著性(P>0.05);T2、T3时刻,试验组患者的MAP、HR、CO均显著高于对照组(P<0.05)。与T0时刻比较,两组患者T1、T2、T3时刻的SVV均显著升高(P<0.05)。T0时刻,两组患者的SVV比较差异无显著性(P>0.05);T1、T2、T3时刻,试验组患者的SVV均显著低于对照组(P<0.05)。试验组患者的总补液量显著多于对照组(P<0.05),低血压发生率和血管活性药物使用率均显著低于对照组(P<0.05)。结论基于IVC-CI导向补液能维持骨科手术患者的血流动力学水平稳定,改善容量状态及容量反应性,并可减少血管活性药物的使用,显著降低蛛网膜下腔阻滞麻醉后低血压的发生率。Objective To study preventive effect of guided fluid infusion strategy based on inferior vena cava collapsibility index(IVC-CI)on hypotension after subarachnoid block anesthesia in orthopedic surgery patients.Method 196 patients who were expected to undergo orthopedic surgery admitted to Cangzhou Hospital of Integrated Traditional and Western Medicine in Hebei Province from June 2019to June 2021 were selected as the research objects.They were divided into experimental group and control group by random number table method,with 98 cases in each group.The control group was given conventional infusion management,and the experimental group was given guiding fluid infusion by IVC-CI 36%as the threshold.Mean artery pressure(MAP),heart rate(HR),cardiac output(CO)and stroke volume variation(SVV)were compared between the two groups at the time of entering the operating room(T0),immediately after anesthesia(T1),5min after anesthesia(T2)and 10min after anesthesia(T3).The amount of fluid rehydration,the occurrence of hypotension and the use of vasoactive drugs after anesthesia were compared between the two groups.Result Compared with T0and T1,MAP,HR and CO in two groups at T2and T3were significantly decreased(P<0.05).At T0and T1,there were no significant differences in MAP,HR and CO between two groups(P>0.05).At T2and T3,MAP,HR and CO in experimental group were significantly higher than those in control group(P<0.05).Compared with T0,SVV at T1,T2and T3was significantly increased in two groups(P<0.05).At T0,there was no significant difference in SVV between the two groups(P>0.05).At T1,T2and T3,the SVV in experimental group was significantly lower than that in control group(P<0.05).The amount of fluid rehydration in experimental group was significantly higher than that in control group(P<0.05),and the incidence of hypotension and utilization rate of vasoactive drugs were significantly lower than those in control group(P<0.05).Conclusion Guiding fluid infusion based IVC-CI can maintain stable hemodynamic level of patients with

关 键 词：蛛网膜下腔阻滞麻醉 下腔静脉塌陷指数 导向补液 骨科手术 血流动力学 低血压 

分 类 号：R614.4[医药卫生—麻醉学]