多普勒超声测量下腔静脉内径呼吸变异指数在高龄全身麻醉患者围术期容量负荷评估中的价值

Value of respiratory variability index of inferior vena cava diameter detected by Doppler ultrasound in perioperative volume load assessment of elderly patients undergoing general anesthesia

目的分析多普勒超声测量下腔静脉内径呼吸变异指数(RVIIVC)在高龄全身麻醉患者围术期容量负荷评估中的价值。方法抽取2019年3月至2020年3月于南阳市第一人民医院行全身麻醉下手术的高龄患者108例,依据麻醉诱导前中心静脉压(CVP)分为低容量(CVP≤0.49 kPa,35例)、正常容量(0.49 kPa1.18k Pa,24例),均监测平均动脉压(MAP)、CVP,行麻醉诱导,使用多普勒超声测量RVIIVC,统计低血压发生率,比较术前30 min、手术1 h及术毕前30 min不同容量、不同血压RVIIVC,分析其相关性。结果手术1 h及术毕前30 min,不同容量RVIIVC值比较差异未见统计学意义(P>0.05);术前30 min,低容量者RVIIVC值高于正常容量者,高容量者RVIIVC值低于正常容量者(P<0.05)。108例患者中低血压发生率为9.26%(10/108)。术前30 min及术毕前30 min,不同血压RVIIVC值比较差异未见统计学意义(P>0.05);手术1 h,低血压者RVIIVC值高于正常血压者(P<0.05)。Pearson分析结果显示,术前30 min,RVIIVC和MAP、CVP呈负相关(r=-0.687、-0.703,P均<0.05);手术1 h,RVIIVC和MAP(r=-0.512)呈负相关,和CVP(r=0.541)呈正相关(P<0.05);术毕前30 min,RVIIVC和MAP(r=0.346)呈正相关,和CVP(r=-0.645)呈负相关(P<0.05)。结论高龄全身麻醉患者手术中采用多普勒超声测量RVIIVC,术前30 min和术中1 h RVIIVC在评估容量负荷、低血压发生风险中有积极意义。

Objective To analyze the value of respiratory variability index of inferior vena cava diameter(RVIIVC)detected by Doppler ultrasound in perioperative volume load assessment of elderly patients undergoing general anesthesia.Methods A total of 108 elderly patients undergoing general anesthesia in the First People’s Hospital of Nanyang from March 2019 to March 2020 were selected.According to the central venous pressure(CVP)before induction of anesthesia,selected patients were divided into low volume patients(CVP≤0.49 kPa,35 cases),normal volume patients(0.49 kPa<CVP≤1.18 kPa,49 cases),and high capacity patients(CVP>1.18 kPa,24 cases).Mean arterial pressure(MAP)and CVP were monitored,anesthesia induction was performed.RVIIVC was detected by Doppler ultrasound.The incidence of hypotension was counted,and RVIIVC of different volumes and different blood pressures were compared 30 min before surgery,1 h after the begin of surgery,and 30 min before the end of surgery,and the correlation was analyzed.Results There was no significant difference in RVIIVC values of different volumes 1 h after the begin of surgery and 30 min before the end of surgery(P>0.05).Thirty minutes before operation,the RVIIVC value of low-volume patients was higher than that of normal volume patients,and the RVIIVC value of high-volume patients was lower than that of normal-volume patients(P<0.05).Among 108 patients,the incidence of hypotension was 9.26%(10/108).There was no significant difference in RVIIVC value of different blood pressures 30 min before operation and 30 min before the end of operation(P>0.05).One hour after the begin of surgery,patients with hypotension had a higher RVIIVC value than that of patients with normal blood pressure(P<0.05).Results of Pearson analysis showed that RVIIVC was negatively correlated with MAP and CVP 30 minutes before surgery(r=-0.687,-0.703;all P<0.05).And RVIIVC was negatively correlated with MAP(r=-0.512),and positively correlated with CVP(r=0.541)1 h after the begin of surgery(P<0.05).Thirty min before the end of operation,RVIIVC was positively correlated with MAP(r=0.346),and negatively correlated with CVP(r=-0.645),P<0.05.Conclusions The detection of RVIIVC by Doppler ultrasonography in elderly patients undergoing general anesthesia has positive significance in assessing the volume load and the risk of hypotension 30 min before surgery and 1 hour after the begin of surgery.