超声监测下腔静脉塌陷指数指导补液对老年患者全身麻醉诱导期循环的影响  

The effect of ultrasound monitoring of inferior vena cava collapse index guiding fluid replacement on circulation in elderly patients during induction of general anesthesia

作　　者：廖孝芸[1] 徐之懿 赵媛[1] 单文燕[1] 邹毅[1] 唐轶珣 胡霞 孟千港 Liao Xiaoyun;Xu Zhiyi;Zhao Yuan;Shan Wenyan;Zou Yi;Tang Yixun;Hu Xia;Meng Qiangang(Department of Anesthesiology,Hunan Provincial People′s Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)麻醉科,长沙410005

出　　处：《中国医师杂志》2023年第5期675-679,共5页Journal of Chinese Physician

基　　金：国家自然科学基金(82101316);湖南省卫生健康委科研项目(202104111006)。

摘　　要：目的探讨超声测量下腔静脉塌陷指数(IVC-CI)指导补液对老年患者全身麻醉诱导期循环的影响。方法选取2021年4月至2022年9月在湖南省人民医院全身麻醉加气管插管下行择期手术的老年患者71例,按随机数字表法分为对照组(35例)和观察组(36例)。麻醉前对两组患者均进行下腔静脉超声检查并计算出IVC-CI值。对于IVC-CI≥40%的患者,观察组麻醉诱导前给予8 ml/kg晶体液,对照组则不予处理。记录两组麻醉诱导至切皮前低血压发生率、血管活性药物使用率及总输液量。记录并比较两组麻醉前(T_(0))、诱导后5 min(T_(1))、气管插管后1 min(T_(2))、气管插管后5 min(T_(3))、气管插管后10 min(T_(4))、切皮前1 min(T_(5))的平均动脉压(MBP)、心率(HR)、血氧饱和度(SpO_(2))、心脏指数(CI)、心脏每搏量变异度(SVV)。结果观察组低血压发生率(27.8%vs 60.0%)、血管活性药物使用率(25.0%vs 48.6%)低于对照组,麻醉诱导期总输液量大于对照组,差异均有统计学意义(均P<0.05)。对照组T_(1)、T_(3)、T_(4)及T_(5)时的SVV、CI、MBP与T0时比较差异有统计学意义(F=3.85,14.66,3.96,均P<0.05);观察组T_(1)、T_(3)、T_(4)及T_(5)时的SVV、CI、MBP与T_(0)时比较差异有统计学意义(F=3.51,13.20,4.35,均P<0.05)。两组患者同时点SVV、CI、MBP、HR、SpO_(2)比较差异无统计学意义(均P>0.05)。结论对于术前IVC-CI≥40%的老年患者,麻醉诱导前给予8 ml/kg晶体液,能显著减少老年患者麻醉诱导期低血压发生率和血管活性药物使用率。Objective To investigate the effect of ultrasound monitoring of inferior vena cava collapse index(IVC-CI)guiding fluid replacement on circulation in elderly patients during induction of general anesthesia.Methods A total of 71 elderly patients who underwent elective surgery under general anesthesia and tracheal intubation at Hunan Provincial People′s Hospital from April 2021 to September 2022 were randomly divided into control group(35 cases)and observation group(36 cases)using a random number table method.Before anesthesia,both groups of patients underwent IVC ultrasound examination and calculated the IVC-CI value.For patients with IVC-CI≥40%,the observation group was given 8 ml/kg of crystal solution before anesthesia induction,while the control group was not treated.The incidence of hypotension,the use of vasoactive drugs,and the total infusion volume from anesthesia induction to skin incision were recorded in two groups.Mean arterial blood pressure(MBP),heart rate(HR),oxygen saturation(SpO_(2)),cardiac index(CI),and cardiac volume variability(SVV)before anesthesia(T_(0)),5 min after induction(T_(1)),1 min after tracheal intubation(T_(2)),5 min after tracheal intubation(T_(3)),10 min after tracheal intubation(T_(4)),and 1 min before skin incision(T_(5))were recorded and compared between the two groups.Results The incidence of hypotension(27.8%vs 60.0%)and utilization rate of vasoactive drugs(25.0%vs 48.6%)in the observation group were lower than those in the control group,and the total infusion volume during anesthesia induction was higher than that in the control group,with statistical significance(all P<0.05).SVV,CI and MBP at T_(1),T_(3),T_(4)and T_(5)were significantly different from those at T0 in the control group(F=3.85,14.66,3.96,all P<0.05).SVV,CI and MBP at T_(1),T_(3),T_(4)and T_(5)in the observation group were significantly different from those at T0(F=3.51,13.20,4.35,all P<0.05).There was no significant difference in SVV,CI,MBP,HR and SpO_(2)between 2 groups(all P>0.05).Conclusions For the eld

关 键 词：超声检查 腔静脉 下 塌陷指数 麻醉 全身 老年人 

分 类 号：R614[医药卫生—麻醉学]