PI、IVC和SCV对预测全身麻醉诱导期低血压的研究

Study of PI, IVC and SCV in predicting hypotension during induction of general anesthesia

目的探讨脉搏灌注指数(PI)、下腔静脉(IVC)和锁骨下静脉(SCV)对预测全身麻醉诱导期低血压的研究。方法回顾性选择2018年1月至2021年12月来新疆医科大学第一附属医院行全身麻醉手术的患者110例,根据全身麻醉诱导期是否出现低血压将110例患者分为2组,其中正常血压组60例,低血压组50例。所有患者在麻醉诱导前均用超声诊断仪检测最小横截面积(SIVCmin)、最大横截面积(SIVCmax)、最小直径(DIVCmin)、最大直径(DIVCmax)、最小横截面积(SSCVmin)、最大横截面积(SSCVmax)、最小直径(DSCVmin)、最大直径(DSCVmax)、下腔静脉的横截面积的塌陷指数(CIsivc)、下腔静脉直径塌陷指数(CIdivc)、锁骨下静脉横截面积塌陷指数(CIssvc)、锁骨下静脉直径塌陷指数(CIdsvc),麻醉诱导至手术开始前的每分钟,记录一次平均动脉压、收缩压、舒张压、心率,取最小值,记录两组诱导前后血流动力学指标、PI及PI增加率。比较两组患者麻醉诱导前后的血流动力学参数水平,比较两组患者麻醉诱导前后的PI、PI增加率、SIVCmax、DIVCmax、SSCVmax、DSCVmax、CIdivc、CIsivc、CIssvc、CIdsvc,以及低血压组麻醉诱导前后以上指标与血流动力学参数的相关性、对全身麻醉诱导期低血压预测价值的ROC曲线及诊断价值。结果麻醉诱导前,两组的舒张压、收缩压、平均动脉压、心率比较,差异均无统计学意义(P>0.05);诱导后,两组的舒张压、收缩压、平均动脉压、心率均明显较基础值降低,而低血压组明显较正常血压组低,差异均有统计学意义(P<0.05)。正常血压组麻醉诱导前后PI、PI增加率、SIVCmax、DIVCmax较低血压组高,CIsivc、CIdivc、CIssvc、CIdsvc明显较低血压组低,差异均有统计学意义(P<0.05);两组的SSCVmax、DSCVmax比较,差异无统计学意义(P>0.05)。低血压组的舒张压降低率、收缩压降低率、平均动脉压降低率与基础PI、诱导后PI、PI增加率、SIVCmax、DIVCmax呈正相关,舒张压降低率、收缩压降低率、平均动脉压降低率与CIsivc、CIdivc、CIssvc、CIdsvc呈负相关(P<0.05)。基础PI≥3.58%,诱导后PI≥4.71%,PI增加率≥46.32%,SIVCmax=2.180 cm^(2),DIVCmax为1.847 cm,CIsivc为40.50%,CIdivc为33.50%%,ROC曲线下面积均超过0.8(P<0.05)。结论SIVCmax、DIVCmax、CIsivc、CIdivc、PI可用于预测全身麻醉诱导期低血压,SCV的预测价值无临床意义。

Objective To investigate the effect of perfusion index(PI),inferior vena cava(IVC)and subclavian vein(SCV)on predicting hypotension during induction of general anesthesia.Methods A total of 110 patients undergoing general anesthesia from January 2018 to December 2021 were selected.110 patients were divided into two groups according to whether hypotension occurred in the induction period of general anesthesia or not,including 60 in the normotensive group and 50 in the hypotension group.All patients tested the minimum inferior vena cava area(SIVCmin),maximum inferior vena cava area(SIVCmax),minimum inferior vena cava diameter(DIVCmin),maximum inferior vena cava diameter(DIVCmax),minimum subclavian vena cava area(SSCVmin),maximum subclavian vena cava area(SSCVmax),minimum subclavianvena cava diameter(DSCVmin),maximum subclavianvena cava diameter(DSCVmax),collapsibility index of inferior vena cava area(CIsivc),collapsibility index of inferior vena cava diameter(CIdivc),collapsibility index of subclavian vein area(CIssvc),collapsibility index of subclavian vein diameter(CIdsvc)anesthesia induction by ultrasound diagnostic instrument until every minute before the start of surgery,recorded the mean arterial pressure,systolic blood pressure,diastolic blood pressure,heart rate,took the minimum value,and recorded the hemodynamic index,PI and PI increase rate before and after induction in both groups.The levels of hemodynamic parameters before and after the induction of anesthesia,the increase rate of PI,PI,SIVCmax,DIVCmax,SSCVmax,DSCVmax,CIdivc,CIsivc,CIssvc,CIdsvc,and the correlation between these indicators and hemodynamic parameters before and after the anesthesia induction,the ROC curve and the diagnostic value of hypotension during general anesthesia induction.Results Before anesthesia induction,there were no differences in diastolic blood pressure,systolic blood pressure,mean arterial pressure and heart rate between the two groups(P>0.05).After induction,the above indexes were lower than the basic value,and the hypotension group was lower than the normal blood pressure group(P<0.05).The PI,PI increase rate,SIVCmax and DIVCmax before and after anesthesia induction in the normal blood pressure group were higher than those in the low blood pressure group;CIsivc,CIdivc,CIssvc and CIdsvc in normal blood pressure group were significantly lower than those in low blood pressure group(all P<0.05).There was no difference in SSCVmax and DSCVmax between the two groups(P>0.05).Diastolic blood pressure reduction rate,systolic blood pressure reduction rate and mean arterial pressure reduction rate in hypotensive group were positively correlated with basal PI,induced PI,PI increase rate,SIVCmax and DIVCmax.The reduction rate of diastolic blood pressure,systolic blood pressure and mean arterial blood pressure were negatively correlated with CIsivc,CIsivc,CIssvc and CIdsvc(P<0.05).Basal PI≥3.58%,post-induction PI≥4.71%,PI increase rate≥46.32%,SIVCmax=2.180 cm^(2),DIVCmax 1.847cm,CIsivc 40.50%,CIdivc 33.50%,area under ROC curve were all more than 0.8(P<0.05).Conclusion SIVCmax,DIVCmax,CIsivc,CIdivc and PI can be used to predict hypotension during induction of general anesthesia,but SCV has no clinical significance.