超声VCI直径对脊柱麻醉后低血压的预测价值

Predictive value of ultrasound measurement of inferior vena cava diameter for hypotension after spinal anesthesia in elderly patients

目的探讨超声测量下腔静脉(vena cava inferior,VCI)直径对老年脊柱麻醉(spinal anaesthesia,SA)后低血压(hypotension after spinal anesthesia,HASA)预测的价值。方法选择2020年1月至2021年6月在温岭市第四人民医院接受91例SA的髋/膝关节手术老年手术患者作为研究对象,观察超声测量呼吸末静脉直径(end-expiratory vena cava inferior,expVCId)与老年SA患者HASA的关系。结果91例SA患者中34例发生HASA,发生率为37.36%,其余为非HASA组。HASA组和非HASA组患者美国麻醉协会分级、expVCId、正性肌力药、血乳酸等比较,差异有统计学意义(P<0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线显示expVCId预测HASA的敏感度、特异性、cut-off、曲线下面积(area under curve,AUC)、95%CI分别为85.3%、64.9%、1.69mm、0.770和0.670~0.852。结论超声测量下腔静脉VCI对老年SA后HASA预测具有一定的价值。

Objective To investigate the value of ultrasonic measurement of vena cava inferior(VCI)diameter in predicting hypotension(HASA)after spinal anesthesia(SA)in the elderly patients.Methods A total of 91 elderly patients undergoing hip/knee joint surgery with SA in the Fourth People's Hospital of Wenling City from January 2020 to June 2021 were selected as the study subjects and the relationship between the ultrasonic measurement of the end expiratory vena cava inferior(expVCId)and HASA in elderly spinal anesthesia patients were observed.Results 34 of 91 patients sufferred HASA,and the incidence rate was 37.36%,the others were non HASA group.There were significant differences between HASA group and non HASA group in terms of American Anesthesia Association classification,expVCId,positive inotropic agents,blood lactic acid,etc,the difference was significant(P<0.05).Receiver operating curve(ROC)showed that the sensitivity,specificity,cut off,area under curve(AUC)and 95%CI of expVCId in predicting HASA were 85.3%,64.9%,1.69mm,0.770 and 0.670-0.852,respectively.Conclusion Ultrasonographic measurement of VCI in inferior vena cava has certain value in predicting hypotension after spinal anesthesia in the elderly patients.