下腔静脉塌陷指数对蛛网膜下腔阻滞后低血压的预测价值

目的探讨下腔静脉塌陷指数(IVC-CI)对蛛网膜下腔阻滞后低血压发生的预测价值。方法选择择期实施蛛网膜下腔阻滞的患者45例,蛛网膜下腔阻滞前应用床旁超声测量3个完整呼吸周期的下腔静脉直径最大值、最小值,并计算IVC-CI。测量后实施蛛网膜下腔阻滞,根据阻滞后30 min内是否发生低血压分为两组,分析IVC-a与低血压的相关性,绘制受试者工作曲线(ROC曲线),得出阈值。结果蛛网膜下腔阻滞麻醉后30 min内出现低血压患者16例。IVC-CI预测蛛网膜下腔阻滞后发生低血压的AUC值为0.804,95%CI为0.658-0.907(P<0.001)。当试验的临界值为40%时,IVC-CI预测的灵敏度以及特异度分别为87.5%、69.0%。结论IVC-CI对蛛网膜下腔阻滞后低血压具有重要的预测价值,IVC-CI>40%提示可能发生蛛网膜下腔阻滞后低血压。

Objective To investigate the predictive value of inferior vena cava collapsibility index(IVC-CI)in hypotension after subarachnoid block.Methods 45 patients scheduled for surgery under subarachnoid block were recruited.Before subarachnoid block,maximal diameter and the minimum diameter of the inferior vena cava were measured in three complete breathing cycles by bedside ultrasound,and IVC-CI was calculated.Subarachnoid block was performed after the measurement,and the patients were divided into two groups according to whether hypotension occurred within 30 minutes after the block.The correlarion between IVC-CI and hypotension was analyzed,and the receiver operating curve(ROC curve)was drawn to get the threshold value.Results Hypotension occurred in 16 patients within 30 min after subarachnoid block anesthesia.The AUC value of IVC-CI for predicting hypotension after subarachnoid block was 0.804,and 95%CI was 0.658~0.907(P<0.001).When the critical value of the test was 40%,the sensitivity and specificity of IVC-CI prediction were 87.5% and 69.0%,respectively.Conclusion IVC-CI has important predictive value for hypotension after subarachnoid block,and IVC-CI>40% indicates the possibility of hypotension after subarachnoid block.