下腔静脉塌陷指数不同阈值指导补液对预防高血压患者全麻诱导后低血压的效果观察  

Observation on the Efficacy of Different Thresholds of Inferior Vena Cava Collapsibility Index-Guided Fluid Infusion for Preventing Hypotension after General Anesthesia Induction in Hypertensive Patients

作　　者：张悦 齐冰雨 郑荣珍[2] ZHANG Yue;QI Bingyu;ZHENG Rongzhen(Yanbian University School of Medicine,Yanji 133000,China;Department of Anesthesiology,Yanbian University Affiliated Hospital,Yanji 133000,China)

机构地区：[1]延边大学医学院,吉林延吉133000 [2]延边大学附属医院麻醉科,吉林延吉133000

出　　处：《延边大学医学学报》2025年第2期43-46,共4页Journal of Medical Science Yanbian University

摘　　要：目的:观察并比较以下腔静脉塌陷指数的两个不同阈值为导向来指导高血压患者术前补液对于预防其发生全麻诱导后低血压的效果。方法:纳入2023年9月—12月在延边大学附属医院行择期全身麻醉手术、美国麻醉医师协会(ASA)分级为Ⅱ~Ⅲ级、年龄为45~80岁的原发性高血压患者90例作为观察对象,随机分为三组,分别为对照组、下腔静脉塌陷指数指导输液1组(IVC-1组)、下腔静脉塌陷指数指导输液2组(IVC-2组),每组各30例。对照组不进行超声检查和术前液体预充;IVC-1组和IVC-2组均于进入手术室前在病房内行下腔静脉超声检查,测定下腔静脉最大直径(IVC_(max))和最小直径(IVC_(min)),并计算下腔静脉塌陷指数(IVC-CI),分别以IVC-CI>40%、IVC-CI>35%作为进行麻醉前输液的标准,在完成输液后进入手术室进行手术。观察和记录三组补液前的平均动脉压、诱导后10 min内的最低平均动脉压,并分别计算每组的低血压发生率、诱导前补液量和诱导后血管活性药物的使用率。结果:与对照组比较,IVC-1组和IVC-2组诱导后低血压发生率、血管活性药物使用率较低(P<0.05)。与IVC-1组比较,IVC-2组诱导后低血压发生率、血管活性药物使用率较低(P<0.05),诱导前补液量较大(P<0.05)。结论:以35%或40%为IVC-CI阈值指导补液治疗均能有效预防高血压患者全麻诱导后低血压的发生,且以IVC-CI>35%的效果更好。Objective:To observe and compare the efficacy of two different thresholds of inferior vena cava collapsibility index(IVC-CI)-guided preoperative fluid infusion in preventing hypotension after general anesthesia induction in hypertensive patients.Methods:Ninety patients aged 45–80 years with primary hypertension,classified as ASA grade II–III,and scheduled for elective surgery under general anesthesia at Yanbian University Affiliated Hospital from September to December 2023 were enrolled.They were randomly divided into three groups(n=30 each):a control group,an IVC-CI-guided fluid infusion group 1(IVC-1 group),and an IVC-CI-guided fluid infusion group 2(IVC-2 group).The control group received neither ultrasonography nor preoperative fluid loading.The IVC-1 and IVC-2 groups underwent preoperative ultrasonography in the ward to measure the maximum(IVC_(max))and minimum(IVCmin)diameters of the inferior vena cava(IVC),and IVC-CI was calculated.Fluid infusion was administered before anesthesia induction if IVC-CI exceeded 40%(IVC-1 group)or 35%(IVC-2 group).All patients were transferred to the operating room after fluid infusion.Mean arterial pressure(MAP)before fluid infusion,the lowest MAP within 10 minutes post-induction,incidence of hypotension,preoperative fluid volume,and usage rate of vasoactive drugs post-induction were recorded and compared.Results:Compared with the control group,both IVC-1 and IVC-2 groups showed lower incidences of post-induction hypotension,reduced vasoactive drug usage,and higher preoperative fluid volumes(P<0.05).The IVC-2 group further demonstrated significantly lower hypotension incidence,lower vasoactive drug usage,and greater preoperative fluid volume compared to the IVC-1 group(P<0.05).Conclusion:Using IVC-CI thresholds of 35%or 40%to guide fluid infusion effectively prevents hypotension after general anesthesia induction in hypertensive patients,with the threshold of IVC-CI>35%demonstrating superior efficacy.

关 键 词：高血压 全麻诱导 下腔静脉塌陷指数 低血压 加速康复 

分 类 号：R614.2[医药卫生—麻醉学]