脉压变异率与下肢止血带相关低血压关系的临床研究  

Clinical Study on the Relationship Between Pulse Pressure Variation and Hypotension Related to Lower Limb Tourniquet

作　　者：李冬琴[1] 杨芙柳 韦秋凤[3] 张光英[3] 林成新[3] LI Dongqin;YANG Fuliu;WEI Qiufeng;ZHANG Guangying;LIN Chengxin(Department of Anesthesiology,The People’s Hospital of Tiandong County,Baise,Guangxi 531500,China;Department of Anesthesiology,The First Affiliated Hospital of Xiamen University,Xiamen,Fujian 361003,China;Department of Anesthesiology,The First Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530021,China)

机构地区：[1]田东县人民医院麻醉科,广西百色531500 [2]厦门大学附属第一医院麻醉科,福建厦门361003 [3]广西医科大学第一附属医院麻醉科,广西南宁530021

出　　处：《中国医药指南》2025年第7期38-41,共4页Guide of China Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题资助项目(Z20210015)。

摘　　要：目的观察全身麻醉机械通气下下肢止血带应用中动脉脉压变异率(PPV)的变化,探讨上止血带期间PPV与止血带相关低血压的关系。方法选择广西医科大学第一附属医院2018年9月至2019年2月择期行全身麻醉复合股神经阻滞下行单侧膝关节镜交叉韧带修补手术患者50例,记录术中止血带放气前5 min(T1),止血带放气后1 min(T2)、3 min(T3)、5 min(T4)以及止血带放气后的最低血压时的动脉脉压变异率(PPV)、收缩压(SBP)、舒张压(DBP)和心率(HR)。结果放气前后各时点PPV、HR且呈先升高后从T2开始降低的趋势,SBP和DBP呈先降低后从T3开始升高的趋势(均P<0.05)。将止血带放气后SBP低于90 mmHg定义为低血压,将T1的PPV通过ROC曲线分析,曲线下面积AUC=0.733,P=0.005,PPV的诊断阈值为7.5%,灵敏度84%,特异度64%。将PPV≤7%分为A组,PPV≥9%分为B组。A组松止血带后低血压阳性率为20%,低于B组的66.67%(P<0.05)。结论在全身麻醉复合股神经阻滞下行单侧膝关节镜下交叉韧带修补术中,止血带放气前的PPV能够预测止血带相关性低血压的发生,建议在止血带放气前将PPV控制在7%以下,以有效降低低血压发生风险。Objective The objectives of this study were to observe the changes in pulse pressure variation(PPV)during tourniquet inflation in lower limb surgery under general anesthesia and mechanical ventilation,as well as to investigate the relationship between intraoperative PPV and tourniquet-associated hypotension.Methods Fifty patients who underwent unilateral knee arthroscopic cruciate ligament repair surgery under general anesthesia combined with femoral nerve block at in the First Affiliated Hospital of Guangxi Medical University from September 2018 to February 2019 were selected.Intraoperative arterial pulse pressure variability(PPV),systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were recorded 5 min before tourniquet deflation(T1),1 min after tourniquet deflation(T2),3 min(T3),5 min(T4),and at the lowest post-tourniquet deflation pressure.Results PPV and HR at all time points before and after deflation and showed a trend of increasing first and then decreasing from T2,and SBP and DBP showed a trend of decreasing first and then increasing from T3(all P<0.05).SBP below 90 mmHg after tourniquet deflation was defined as hypotension,and PPV at T1 was analysed by ROC curve with area under the curve AUC=0.733,P=0.005,and the diagnostic threshold of PPV was 7.5%,with sensitivity of 84%and specificity of 64%.PPV≤7%was divided into group A and PPV≥9%into group B.The positive rate of hypotension after tourniquet release was 20%in group A,which was lower than that of group B,which was 66.67%(P<0.05).Conclusions In patients undergoing unilateral arthroscopic cruciate ligament repair under general anesthesia with femoral nerve block,pre-tourniquet deflation PPV can predict the occurrence of tourniquet-associated hypotension.Maintaining a PPV of≤7%prior to tourniquet release effectively mitigates the incidence of hypotension resulting from deflation.

关 键 词：脉压变异率 止血带相关低血压 膝关节手术 

分 类 号：R544.2[医药卫生—心血管疾病]