不同体位肱动脉峰流速差值对产妇腰麻后仰卧位低血压综合征的预测作用

Predictive effect of the difference of brachial artery peak velocity in different positions on Supine hypotension syndrome of parturient after spinal anesthesia

目的通过超声测量产妇不同体位肱动脉峰流速的变化,探讨其预测腰麻后发生仰卧位低血压综合征(supine hypotension syndrome,SHS)的有效性。方法拟在腰麻下行择期剖宫产的单胎产妇,ASAⅠ或Ⅱ级,根据腰麻后是否发生SHS(上肢SBP下降30 mm Hg或下降至80 mm Hg以下)分为SHS组和非SHS组。记录麻醉前仰卧位与左侧卧位的HR、SBP、DBP,同时超声测量肱动脉峰流速。并计算变换体位前后上述指标的差值(Δ),对组间比较有统计学意义的指标绘制受试者工作特征(ROC)曲线,评价各指标对腰麻后发生SHS的预测作用。结果纳入196例产妇,有89例(45.4%)腰麻后发生了SHS。SHS组ΔSBP、ΔDBP、肱动脉峰流速最小值差值(ΔVpmin)、肱动脉峰流速变异度差值(ΔΔVp)明显高于非SHS组(P<0.05),ΔSBP、ΔDBP、ΔVpmin、ΔΔVp的受试者工作特征曲线下面积(AUC)分别为0.711(95%CI 0.575~0.846)、0.573(95%CI 0.419~0.727)、0.948(95%CI0.895~0.987)、0.864(95%CI 0.770~0.958),诊断界值分别为17.5 mm Hg、7.6 mm Hg、17.8 cm/s、13.1%。结论产妇不同体位下超声测量肱动脉峰流速差值可有效预测腰麻后SHS的发生,其中ΔVpmin≥17.8 cm/s有较好的预测作用。

Objective To investigate the effectiveness of predicting the incidence of supine hypotension syndrome（ SHS） after spinal anesthesia measured by ultrasonic measurement of the variation of brachial artery peak velocity in different positions of parturient. Methods Parturient scheduled for elective cesarean section,ASA physical status Ⅰ or Ⅱ,were divided into SHS group and no-SHS group（ SBP in the upper extremity decreased by 〉30 mm Hg or decreased to 〈80 mm Hg） after spinal anesthesia.HR,SBP,DBP of supine position and left lateral position before anesthesia were recorded,and brachial artery peak velocity were measured by Ultrasonic. The differences of the above indexs before and after the transformation position were calculated. The receiver operating characteristic curve（ ROC） was plotted by indexs of which P values were less than 0. 05,to evaluate the predictive effect of each index on SHS after spinal anesthesia.Results Among the 196 patients,89 cases（ 45. 4%） developed SHS after spinal anesthesia. SBP,DBP,peak velocity of brachial artery（ Vpmin） and brachial artery peak velocity variation（ ΔVp） were different before and after the transformation position（ P〈0. 05）. The difference in SHS group was significantly higher than no-SHS group. The areas under ROC curve（ AUC） of ΔSBP,ΔDBP,ΔVpmin,ΔΔVp were 0. 711（ 95%CI 0. 575-0. 846）,0. 573（ 95%CI 0. 419-0. 727）,0. 948（ 95%CI 0. 895-0. 987）,0. 864（ 95%CI 0. 770-0. 958）,and the cut-off values were 17. 5 mm Hg,7. 6 mm Hg,17. 8 cm/s,and 13. 1%. Conclusion The difference of brachial artery peak velocity measured by ultrasonic in different positions of parturient can effectively predict the occurrence of SHS,in which ΔVpmin≥ 17. 8 cm/s has better predictive effect.