腔静脉血容量状态参数对骨科手术腰麻后低血压早期预测价值

Value of analyzing the parameters of vena cava blood volume status in early prediction of hypotension after spinal anesthesia in orthopaedic surgery

目的探究下腔静脉塌陷指数(IVC-CI)和脉搏灌注变异指数(PVI)2项腔静脉血容量状态参数对骨科手术患者腰麻后低血压的早期预测价值。方法选取2020-10-01-2021-10-01天津市第一中心医院收治的106例行骨科手术治疗患者为研究对象。所有患者均给予相同麻醉方式,术前测量心率(HR)、舒张压(DBP)、平均动脉压(MAP)、收缩压(SBP)、IVC-CI和PVI等相关指标。比较2组患者腰麻后低血压发生情况,以logistic回归分析患者术后低血压的影响因素,以受试者工作特征(ROC)曲线评估IVC-CI对腰麻低血压的预测价值。结果106例骨科手术患者共发生低血压31例(29.25%),血压正常75例(70.75%)。单因素分析结果显示,术前促血管收缩性药物(χ^(2)=8.857,P=0.003)、下腔静脉超声指导输液(χ^(2)=7.705,P=0.006)、基础疾病为高血压(χ^(2)=8.514,P=0.004)与低血压发生有关。低血压组IVC-CI为(39.48±4.21)%,高于血压正常组的(33.42±3.88)%,t=7.135,P<0.001;低血压组PVI(19.61±3.94)%,高于血压正常组的(14.82±3.50)%,t=6.176,P<0.001。二元logistic回归分析结果显示,高血压(OR=2.875,95%CI为1.154~7.163,P=0.023)、IVC-CI(OR=1.511,95%CI为1.257~1.816,P<0.001)及PVI值升高(OR=1.432,95%CI为1.222~1.677,P<0.001)为腰麻患者低血压的危险因素,下腔静脉超声指导输液(OR=0.288,95%CI为0.117~0.710,P=0.007)、促血管收缩性药物使用(OR=0.285,95%CI为0.102~0.796,P=0.017)是腰麻后低血压的保护因素。ROC曲线结果显示,IVC-CI、PVI预测腰麻患者低血压的曲线下面积分别为0.867和0.809,联合预测为0.941。结论高血压、IVC-CI及PVI值升高为腰麻患者低血压的危险因素,促血管收缩性药物使用、下腔静脉超声指导输液是腰麻后低血压的保护因素,且IVC-C、PVI预测腰麻后低血压的发生的价值较好。

Objective To explore the early predictive value of inferior vena cava collapse index(IVC-CI)and pulse perfusion variability index(PVI)as two parameters of vena cava blood volume status for postoperative hypotension in orthopedic surgery patients under spinal anesthesia.Methods Totally 106 orthopedic surgery patients admitted to Tianjin First Central Hospital from October 1,2020 to October 1,2021 were selected as the research subjects.All patients were given the same anesthesia method,and related indicators such as heart rate(HR),diastolic blood pressure(DBP),mean arterial pressure(MAP),systolic blood pressure(SBP),IVC-CI,and PVI were measured before surgery.The incidence of postoperative hypotension in two groups of patients after spinal anesthesia was compared,logistic regression analysis to was used to identify the influencing factors of postoperative hypotension,and the predictive value of IVC-CI for spinal anesthesia hypotension was evaluated using receiver operating characteristic(ROC)curves.Results Among 106 orthopedic surgery patients,31 cases(29.25%)experienced hypotension,while 75 cases(70.75%)had normal blood pressure.The results of univariate analysis showed that preoperative vasoconstrictive drugs(χ^(2)=8.857,P=0.003),inferior vena cava ultrasound-guided infusion(χ^(2)=7.705,P=0.006),and hypertension as the underlying disease(χ^(2)=8.514,P=0.004)were related to the occurrence of hypotension.The IVC-CI of the hypotension group was(39.48±4.21)%,which was higher than that of the normal blood pressure group(33.42±3.88)%,t=7.135,P<0.001.The PVI of the hypotension group(19.61±3.94)%was higher than that of the normal blood pressure group(14.82±3.50)%,t=6.176,P<0.001.The results of binary logistic regression analysis showed that hypertension(OR=2.875,95%CI was 1.154—7.163,P=0.023),IVC-CI(OR=1.511,95%CI was 1.257-1.816,P<0.001),and elevated PVI values(OR=1.432,95%CI was 1.222-1.677,P<0.001)were risk factors for hypotension in patients with lumbar anesthesia.Inferior vena cava ultrasound guided infusion(OR=0.288,95%CI was 0.117-0.710,P=0.007),and the use of vasoconstrictive drugs(OR=0.285,95%CI was 0.102-0.796,P=0.017)were protective factors for hypotension after spinal anesthesia.The ROC curve results showed that the area under curve predicted by IVC-CI and PVI for hypotension in patients with lumbar anesthesia were 0.867 and 0.809,respectively,and the combined predicted was 0.941.Conclusions Hypertension,elevated IVC-CI and PVI values are risk factors for hypotension in patients undergoing spinal anesthesia.The use of vasoconstrictive drugs and guidance of intravenous infusion with inferior vena cava ultrasound are protective factors for hypotension after spinal anesthesia.Moreover,IVC-C and PVI have good predictive value for the occurrence of hypotension after spinal anesthesia.