老年患者深吸气相颈内静脉变异度与丙泊酚诱导血压下降程度的相关性  

The relationship between the variability of the internal jugular vein during deep inspiration and propofol-induced hypotension in eld patients

作　　者：魏雪莲 李振平 周清河 Wei Xuelian;Li Zhenping;Zhou Qinghe(Zhejiang Chinese Medical University-Jiaxing University Joint Graduate Training Base,Hangzhou 310053,China;Department of Anesthesiology and Pain Medicine,the Affiliated Hospital of Jiaxing University,Jiaxing City 314000,China)

机构地区：[1]浙江中医药大学-嘉兴大学研究生联合培养基地,杭州310053 [2]嘉兴大学附属医院麻醉与疼痛医学中心,嘉兴314000

出　　处：《中华实验外科杂志》2024年第10期2341-2344,共4页Chinese Journal of Experimental Surgery

基　　金：浙江省中医药重点创新团队(2022-19);嘉兴市医学重点学科-麻醉学(2023-ZC-001)。

摘　　要：目的:探讨深吸气相颈内静脉变异度(IJVV)与丙泊酚诱导期间血压降低程度之间的相关性。方法:将60例于2023年9月至2024年1月在嘉兴大学附属医院行择期全身麻醉手术的老年患者纳入本研究。在平静吸气相和深吸气相利用超声测量其颈内静脉(IJV)最大直径(IJV_(max)-D)和最小直径(IJV_(min)-D)以及IJV最大横截面积(IJV_(max)-A)和最小横截面积(IJV_(min)-A),并据此计算颈内静脉直径变异度(IJVV-D)及颈内静脉横截面积变异度(IJVV-A)。使用Spearman相关性分析深吸气相IJVV与丙泊酚诱导期间血压下降之间的相关性。非正态分布数据组间比较采用Wilcoxon秩和检验。结果:平静吸气相IJVV-A(r=0.594,P<0.01)和IJVV-D(r=0.593,P<0.01)与血压下降程度均呈正相关;深吸气相IJVV-A(r=0.858,P<0.01)和IJVV-D(r=0.732,P<0.01)与血压下降程度均呈正相关;IJVV-A的曲线下面积(AUC)为0.900[95%置信区间(CI):0.821~0.979,P<0.01],敏感度81.5%,特异度84.8%,截断值为23.42%。结论:深吸气相IJVV与丙泊酚诱导后血压下降程度之间明显相关。深吸气相颈内静脉变异度可为术前液体管理提供可行的策略参考。Objective:This study aimed to explore the correlation between IJVV during deep inspiration and the degree of blood pressure decrease during propofol induction.Methods:Sixty elderly patients who underwent elective general anesthesia in Jiaxing University Affiliated Hospital from September 2023 to January 2024 were included in the study.During both calm and deep inspiration phase,the maximum diameter(IJV_(max)-D),minimum diameter(IJV_(min)-D),maximum area(IJV_(max)-A),and minimum area(IJV_(min)-A)of the IJV were measured.From these measurements,the diameter variability of IJV(IJVV-D)and cross-sectional area variability of IJV(IJVV-A)were calculated.Use Spearman correlation analysis to explore the connection between the deep inspiration phase of IJVV and the degree of blood pressure while administering propofol.Non-normally distributed data were compared between groups using the Wilcoxon rank-sum test.Results:The extent of blood pressure decrease during propofol induction was significantly correlated with both IJVV-D(r=0.593,P<0.01)and IJVV-A(r=0.594,P<0.01)during calm inspiration,as well as with IJVV-D(r=0.732,P<0.01)and IJVV-A(r=0.858,P<0.01)during deep inspiration.Notably,the correlation between IJVV-A during deep inspiration and the degree of blood pressure decrease was the strongest(r=0.858,P<0.01).The area under the curve(AUC)for IJVV-A was 0.900[95%confidence interval(CI):0.821-0.979,P<0.01],with a sensitivity of 81.5%,specificity of 84.8%,and a cut-off value of 23.42%.Conclusion:There is a significant correlation between deep inspiration IJVV and the degree of blood pressure decrease after propofol induction.Deep inspiration internal jugular vein variability can provide a feasible strategy reference for preoperative fluid management.

关 键 词：颈内静脉变异度 深吸气相 丙泊酚 低血压 

分 类 号：R614[医药卫生—麻醉学]