超声测量下腔静脉塌陷指数在评估危重症产妇麻醉前血容量中的应用

Application of ultrasound measurement of inferior vena cava collapse index in evaluating pre-anesthesia blood volume in critically ill pregnant women

目的探讨超声测量危重症产妇下腔静脉塌陷指数(IVC-CI)用于评估其麻醉前血容量的临床价值。方法选取蚌埠医学院第一附属医院2021年9月—2022年7月择期行剖宫产手术的危重症产妇90例,采用随机数字表法分为常规补液组(C组)、中心静脉压补液组(CVP组)、超声测量下腔静脉补液组(IVC组),每组30例。记录并比较3组患者各时点收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、乳酸值(Lac),手术时间、出血量、液体总入量、血管活性药使用率和腰麻后低血压发生率。记录IVC组补液前后中心静脉压(CVP)、最大下腔静脉直径(dIVCmax)和最小下腔静脉直径(dIVCmin),计算IVC-CI并分析其与CVP的相关性。结果在麻醉后5 min(T1)、胎儿取出后(T2)、手术结束时(T3),C组SBP、DBP、MAP值均低于CVP组和IVC组(P<0.05);在T1时点,C组HR、乳酸值均高于CVP组和IVC组(F=11.650、7.860,P<0.05)。C组液体总入量[(740.00±156.01)mL]低于CVP组[(975.00±198.54)mL]和IVC组[(967.33±179.60)mL,F=16.711,P<0.001]。IVC组中dIVCmax、dIVCmin与CVP呈正相关关系(r=0.937、0.873,P<0.05),IVC-CI与CVP呈负相关关系(r=-0.688,P<0.05)。结论下腔静脉塌陷指数可用于评估危重症产妇麻醉前血容量,并指导补液。

Objective To explore the clinical value of ultrasound measurement of inferior vena cava collapse index(IVC-CI)in critically ill pregnant women for evaluating their pre-anesthesia blood volume.Methods A total of 90 critically ill pregnant women who underwent elective cesarean section at the First Affiliated Hospital of Bengbu Medical College from September 2021 to July 2022 were selected and randomly divided into a routine fluid replacement group(C group),a central venous pressure fluid replacement group(CVP group),and an ultrasound measured inferior vena cava fluid replacement group(IVC group),with 30 cases in each group.The systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR),lactate value(Lac),surgical time,bleeding volume,total fluid intake,vasoactive drug use rate,and incidence of postoperative hypotension among three groups of patients at different time points were record and compared.The central venous pressure(CVP),maximum inferior vena cava diameter(dIVCmax),and minimum inferior vena cava diameter(dIVCmin)before and after fluid replacement in the IVC group were record,the IVC-CI was calculated and analyzed its correlation with CVP.Results At 5 minutes after anesthesia(T1),after fetal removal(T2),and at the end of surgery(T3),the SBP,DBP,and MAP values in Group C were lower than those in the CVP and IVC groups(P<0.05).At time point T1,the HR and lactate values in Group C were higher than those in the CVP and IVC groups(F=11.650,7.860,P<0.05).The total liquid intake in Group C[(740.00±156.01)mL]was lower than that in the CVP[(975.00±198.54)mL]and IVC groups[(967.33±179.60)mL,F=16.711,P<0.001].In the IVC group,dIVCmax and dIVCmin were positively correlated with CVP(r=0.937,0.873,P<0.05),while IVC-CI was negatively correlated with CVP(r=-0.688,P<0.05).Conclusion The inferior vena cava collapse index can be used to evaluate the pre-anesthesia blood volume of critically ill pregnant women and guide fluid replacement.