脑电双频指数预测剖宫产产妇腰麻后发生低血压的临床价值

The value of bispectral index in predicting hypotension after spinal anesthesia in parturients undergoing cesarean section

目的分析脑电双频指数(BIS)预测剖宫产产妇腰麻后发生低血压的临床价值。方法选取2020年1月至2021年2月湖南省妇幼保健院收治的121例行择期剖宫产的产妇作为研究对象。根据腰麻后仰卧位10min内低血压的发生情况,将其分为高血压组(H组,n=59)和低血压组(N组,n=62)。采用Pearson相关性分析腰麻前后BIS值与腰麻后低血压之间的关系,并使用受试者工作特征(ROC)曲线论证腰麻前后BIS值对腰麻后低血压的预测价值。采用多因素Logistic回归分析产妇腰麻后发生低血压的危险因素,并建立预测模型;利用ROC曲线和内部数据验证对模型预测效能进行评估。结果与N组比较,腰麻后H组的平均动脉压(MAP)和BIS值均明显降低,心率(HR)明显升高,新生儿乳酸(Lac)明显更高,差异具有统计学意义(P<0.05)。腰麻前后BIS值与腰麻后MAP呈明显正相关(P<0.01),相关系数分别为0.822,0.840。腰麻前后BIS值预测腰麻后低血压的曲线下面积(AUC)分别为0.816、0.910,临界值分别为69、75,灵敏度分别为86.53%、93.20%,特异度分别为73.56%、88.41%(P<0.05)。宫高越高、腹围越大、胎儿预测体重越大、BIS值越小、麻醉后3min平面≥T_(8)、手术开始麻醉平面>T_(6)是剖宫产产妇腰麻后发生低血压的独立危险因素(P<0.05)。内部数据验证结果显示,2个模型一致性均较好,纳入BIS值的预测模型AUC为0.835(95%CI:0.805~0.974),预测灵敏度为82.6%,特异度为86.7%,优于未纳入BIS值模型。结论腰麻前BIS值和腰麻后BIS值均能预测腰麻后低血压的发生,且腰麻后快速实时测量BIS值有更高的临床价值。

Objective To explore the value of bispectral index(BIS)in predicting hypotension after spinal anesthesia in parturients undergoing cesarean section.Methods 121 parturients who underwent elective cesarean section in Hunan Maternal and Child Health Hospital from January 2020 to February 2021 were selected.According to whether hypotension occurred within 10 min of supine position after spinal anesthesia,the parturients were divided into hypertension group(group N,n=62)and hypotension group(group H,n=59).Pearson correlation was used to analyze the relationship between BIS before and after spinal anesthesia and hypotension after spinal anesthesia,and the receiver operator characteristic(ROC)curve was used to demonstrate the predictive value of BIS before and after spinal anesthesia in evaluating hypotension after spinal anesthesia.Multivariate Logistic regression analysis was used to screen the risk factors of hypotension after spinal anesthesia,and a predictive model was established,and the predictive efficiency of the model was evaluated by ROC curve and internal data.Results Compared with group N,the MAP and BIS of pregnant women after spinal anesthesia in group H were significantly lower,while the HR was significantly higher,and the Lac of newborns was significantly higher(P<0.05).BIS values before and after lumbar anesthesia were significantly positively correlated with MAP values after spinal anesthesia(P<0.01),and the correlation coefficients were 0.822 and 0.840,respectively.The AUC of BIS before and after spinal anesthesia for predicting hypotension after spinal anesthesia were 0.816 and 0.910,the critical values were 69,75,the sensitivity were 86.53,93.20,and the specificity were 73.56,88.41 respectively(P<0.05).The higher the uterine height,the larger the abdominal circumference,the larger the predicted fetal weight,the smaller of BIS,the plane 3 minutes after anesthesia≥T_(8),the plane of anesthesia at the beginning of operation>T_(6) were the independent risk factors for hypotension after spinal anesthesia in parturients undergoing cesarean section.The verification results of internal data show that the consistency of the two models is good.The area under the curve of the prediction model included in BIS is 0.835(95%CI:0.805-0.974),the prediction sensitivity is 82.6%,and the specificity is 86.7%,which is better than that not included in the BIS model.Conclusions The BIS before and after spinal anesthesia can predict the occurrence of hypotension after spinal anesthesia,and the rapid real-time measurement of BIS value after spinal anesthesia has better clinical value.