下腔静脉塌陷指数指导补液对胃肠手术患者全身麻醉诱导后血压和心率的影响

Effect of collapse index of inferior vena cava in guiding fluid infusion on blood pressure and heart rate after general anesthesia induction in patients undergoing gastrointestinal surgery

目的探讨下腔静脉塌陷指数(IVC-CI,采用超声评估)指导补液对胃肠手术患者全身麻醉诱导后MAP和HR的影响。方法90例择期胃肠手术患者随机均分为IVC-CI指导补液晶体组(IVC-1组)、IVC-CI指导补液胶体组(IVC-2组)和对照组(C组)。全身麻醉诱导后,C组不予超声评估,维持晶体补液速度10 ml·kg^-1·h^-1;IVC-1组和IVC-2组行下腔静脉超声评估,以IVC-CI 40%为阈值指导补液,麻醉诱导前30 min内分别输注晶体液和胶体液8 ml/kg补充量。记录各组患者麻醉诱导前液体输注量以及液体输注前、液体输注30 min后和麻醉诱导后MAP和HR的变化。记录各组患者麻醉诱导期间心血管活性药物使用和不良反应发生情况。结果与C组相比,IVC-1组和IVC-2组麻醉诱导前液体输注量增加(P<0.05)。麻醉诱导后,IVC-1组和C组MAP低于液体输注后(P<0.05),IVC-1组和IVC-2组MAP高于C组(P<0.05),IVC-2组MAP高于IVC-1组(P<0.05)。麻醉诱导期间IVC-1组和IVC-2组心血管活性药物使用少于C组(P<0.05),且IVC-2组少于IVC-1组(P<0.05)。三组均未出现明显不良反应。结论对于易发生麻醉诱导后低血压的胃肠手术患者,麻醉诱导前以IVC-CI 40%为阈值指导补液,尤其输入胶体液,能够减少诱导后低血压的发生。

Objective To investigate the effect of collapse index of inferior vena cava(IVC-CI,evaluated by ultrasound)in guiding fluid infusion on MAP and HR after general anesthesia induction in the patients undergoing gastrointestinal surgery.Methods Ninety patients scheduled for gastrointestinal surgery were randomly and equally divided into three groups.Group C was infused crystalloid solution 10 ml·kg^-1·h^-1 without the guidance of IVC-CI before anesthesia induction.Within 30 minutes before anesthesia induction,the patients in groups of IVC-1 and IVC-2 were infused crystalloid 8 ml/kg and colloid solution 8 ml/kg,respectively,which was guided by IVC-CI 40%as the threshold for fluid infusion.The volume of fluid infusion before anesthesia induction and the changes of MAP and HR before and 30 minutes after infusion and after anesthesia induction were recorded.The use of cardiovascular active drugs and adverse responses during anesthesia induction were recorded in the three groups.Results The volume of fluid infusion before anesthesia induction was more in groups of IVC-1 and IVC-2 than that in group C(P<0.05).The MAP in groups of IVC-1 and IVC-2 was lower after anesthesia induction than that before(P<0.05),which after anesthesia induction was higher in groups of IVC-1 and IVC-2 than that in group C(P<0.05)and in group IVC-2 than that in group IVC-1(P<0.05).During anesthesia induction,the utilization of cardiovascular active drugs was less in groups of IVC-1 and IVC-2 than that in group C(P<0.05),which was less in group IVC-2 than that in group IVC-1(P<0.05).There were no obvious adverse responses in the three groups.Conclusion In the patients undergoing gastrointestinal surgery and being prone to hypotension after anesthesia induction,the fluid infusion guided by IVC-CI 40%as a threshold before anesthesia induction can reduce the occurrence of hypotension after anesthesia induction,for which colloid solution is better than crystalloid solution.