下腔静脉塌陷指数指导补液对骨折手术腰麻患者血流动力学及低血压风险的影响  

Effect of Inferior Vena Cava Collapsibility Index Guiding Fluid Supplementation on Hemodynamics and Hypotension Risk in Patients with Lumbar Anesthesia during Fracture Surgery

作　　者：刘忠文 LIU Zhongwen(Department of Anesthesiology,Zong Renqing Memorial Hospital,Kunshan,Jiangsu Province,215300 China)

机构地区：[1]昆山宗仁卿纪念医院麻醉科,江苏昆山215300

出　　处：《世界复合医学》2023年第12期146-149,共4页World Journal of Complex Medicine

摘　　要：目的 探讨下腔静脉塌陷指数(inferior vena cava collapsibility index, IVC-CI)指导补液在骨折手术患者中的应用效果。方法 便利选取2021年5月—2023年2月昆山宗仁卿纪念医院收治的骨折手术患者86例为研究对象,按照随机数表法分为研究组、对照组,两组均接受10 mL/(kg·h)速度补液,其中研究组(43例)进行下腔静脉超声监测,当IVC-CI>50%时加快补液使其低于50%,对比两组不同时间点[麻醉前(T0)、麻醉后1 min(T1)、麻醉后30 min(T2)]基础体征[平均动脉压(mean arterial pressure, MAP)、心率(heart rate, HR)、二氧化碳分压(partial pressure of carbon dioxide, PaCO_(2))]、临床指标(麻醉前输液量、总输液量、血管活性药物使用情况)、腰麻后低血压发生率。结果 T1两组MAP、HR均降低,且研究组均高于对照组,差异有统计学意义(P均<0.05);两组血管活性药物使用对比,差异无统计学意义(P>0.05)。研究组麻醉前输液量(390.21±15.24)mL、总输液量(321.24±14.15)mL均高于对照组的(201.25±10.24)、(260.25±12.15)m L,差异有统计学意义(t=67.486、21.444,P<0.05)。研究组低血压2例(4.65%),对照组10例(23.26%),两组对比,差异有统计学意义(χ^(2)=6.198,P<0.05)。结论 IVC-CI指导补液在骨折手术患者中能够改善患者体征的稳定性,并且能够降低低血压发生率,应用效果良好。Objective To investigate the effect of inferior vena cava collapsibility index(IVC-CI)in guiding fluid supplementation in patients with fracture surgery.Methods A total of 86 patients with fracture surgery admitted to Zong Renqing Memorial Hospital in Kunshan from May 2021 to February 2023 were conveniently selected as the study objects and divided into two groups(study group and control group)according to random number table method.Both groups received 10 mL/(kg·h)rate of fluid replacement.The study group(43 cases)performed ultrasound monitoring of inferior vena cava.When IVC-CI>50%,accelerated fluid supplementation to reduce it to below 50%.The basic signs[mean arterial pressure(MAP),heart rate(HR)and partial pressure of carbon dioxide(PaCO_(2))],clinical indicators(pre-anesthetic infusion volume,total infusion volume,vasoactive drug use),incidence of hypotension after lumbar anesthesia were compared between the two groups at different time points[before anesthesia(T0),1 min(T1)and 30 min(T2)after anesthesia].Results MAP and HR were decreased in both T1 groups,the study group was higher than the control group,and the difference was statistically significant(both P<0.05).There was no statistically significant difference in the use of vasoactive drugs between the two groups(P>0.05).The pre-anesthesia infusion volume(390.21±15.24)mL and total infusion volume(321.24±14.15)mL in the study group were higher than those in the control group(201.25±10.24)mL and (260.25±12.15) mL, and the difference was statistically significant (t=67.486, 21.444, P<0.05). There were 2 cases of hypotension in the study group (4.65%) and 10 cases in the control group (23.26%), and the difference was statistically significant (χ^(2)=6.198, P<0.05). Conclu sion IVC-CI guided fluid supplementation can improve the stability of patients' physical signs and reduce the incidence of hypotension in pa tients undergoing fracture surgery, and the application effect is good.

关 键 词：骨折 蛛网膜下腔阻滞麻醉 输液管理 下腔静脉塌陷指数 

分 类 号：R614[医药卫生—麻醉学]