下腔静脉塌陷指数指导补液对老年高血压患者蛛网膜下腔麻醉后低血压的影响  

Effect of rehydration guided by the inferior vena cava collapse index on hypotension after subarachnoid anesthesia in elderly patients with hypertension

作　　者：杨静茹 王立伟 闫莉[2] 王凯[2] 刘莹[1] 朱璇璇 Yang Jingru;Wang Liwei;Yan Li;Wang Kai;Liu Ying;Zhu Xuanxuan(Anesthesiology School of Xuzhou Medical University,Xuzhou 221004,China;Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou 221009,China;Department of Anesthesiology,Suining County People's Hospital,Xuzhou 221200,China)

机构地区：[1]徐州医科大学麻醉学院,徐州221004 [2]徐州市中心医院麻醉科,徐州221009 [3]徐州市睢宁县人民医院麻醉科,徐州221200

出　　处：《国际麻醉学与复苏杂志》2022年第11期1172-1179,共8页International Journal of Anesthesiology and Resuscitation

基　　金：徐州市科技计划项目(KC16SH008)。

摘　　要：目的探讨下腔静脉塌陷指数(inferior vena cava collapse index,IVC-CI)指导补液对老年高血压患者蛛网膜下腔麻醉后低血压的影响。方法选取睢宁县人民医院择期行髋关节置换术的老年高血压患者120例,采用随机数字表法将患者分为对照组(C组)与干预组(E组),每组60例;根据入室时IVC-CI值是否小于35%对C组和E组进行再分组,C1组(22例)、E1组(24例)为IVC-CI<35%,C2组(38例)、E2组(36例)为IVC-CI≥35%。所有患者进入手术室后按照4-2-1法则补充术前液体生理需要量,C组患者的超声结果对补液不产生影响,E2组则通过加快补液将IVC-CI值降至35%以下再进行蛛网膜下腔麻醉,E1组与C组维持10 ml·kg-1·h-1补液速度不变,扩容30 min后对患者实施麻醉。比较4组患者一般资料(性别比、年龄、BMI、心功能分级、ASA分级、基础IVC-CI分布情况、高血压病史、降压药物使用情况、手术时间、出血量及尿量)。监测并记录患者入室(T0)、蛛网膜下腔麻醉前(T1)、麻醉后1 min(T2)、麻醉后5 min(T3)、麻醉后10 min(T4)、麻醉后30 min(T5)时MAP、心率。比较4组患者T0、T1时刻IVC-CI水平,蛛网膜下腔麻醉后30 min内低血压发生率,使用心血管活性药物例数,蛛网膜下腔麻醉前、麻醉后30 min内输液量以及T0、术毕时刻乳酸(lactic acid,Lac)及PaCO_(2)。所有纳入研究患者根据低血压定义分为低血压组(46例)与正常血压组(74例),通过Logistic回归分析探讨影响患者蛛网膜下腔麻醉后低血压发生的相关因素。通过受试者工作特征(receiver operating characteristic,ROC)曲线分析IVC-CI在预测蛛网膜下腔麻醉后患者发生低血压的诊断效能。结果4组患者一般资料中性别比、年龄、BMI、心功能分级、ASA分级、基础IVC-CI分布情况及高血压病史、手术时间、出血量及尿量比较,差异无统计学意义(P>0.05)。组间比较,MAP、心率差异无统计学意义(P>0.05)。与T1时刻比较,各组MAPObjective To explore the effect of rehydration guided by the inferior vena cava collapse index(IVC⁃CI)on hypo⁃tension after subarachnoid anesthesia in elderly patients with hypertension.Methods A total of 120 elderly patients with hyperten⁃sion undergoing elective hip replacement surgery in Suining County People's Hospital were selected and divided into a control group(group C)and intervention group(group E)by random number table method,with 60 patients in each group.Groups C and E were subdi⁃vided according to whether the IVC⁃CI value was less than 35%at the time of entry.Group C1(n=22)and group E1(n=24)were defined as IVC⁃CI<35%,and group C2(n=38)and group E2(n=36)were defined as IVC⁃CI≥35%.After all patients entered the operating room,and the preoperative fluid physiological requirements were supplemented according to the 4⁃2⁃1 rule.The ultrasound results of group C did not affect fluid rehydration.In group E2,the IVC⁃CI value was reduced to below 35%by accelerating fluid rehydration,and then sub⁃arachnoid anesthesia was performed.In groups E1 and C,the infusion rate of 10 ml·kg−1·h−1 remained unchanged,and then subarachnoid anesthesia was performed after 30 min of volume expansion.The four groups'general data(gender ratio,age,body mass index(BMI),car⁃diac function classification,American Society of Anesthesiologists(ASA)classification,basic IVC⁃CI distribution and history of hyperten⁃sion,operation time,blood loss and urine volume)were compared.The levels of mean arterial pressure(MAP)and heart rate(HR)at entry(T0),before anesthesia(T1),1 min after anesthesia(T2),5 min after anesthesia(T3),10 min after anesthesia(T4),and 30 min after anes⁃thesia(T5)were monitored and recorded.The level of IVC⁃CI at T0 and T1,the incidence of hypotension within 30 min after subarachnoid anesthesia,the number of active cardiovascular drugs used,the infusion volume before and within 30 min after subarachnoid anesthesia,lactic acid(Lac)as well as arterial partial pressure of carbon dioxide(

关 键 词：下腔静脉塌陷指数 低血压 蛛网膜下腔麻醉 目标导向补液 高血压 老年人 

分 类 号：R614[医药卫生—麻醉学]