腰麻前超声CI、IVCe/Ao联合ΔCBF预测腰麻后低血压的ROC曲线分析

ROC curve analysis of ultrasound CI,IVCe/Ao combined withΔCBF before lumbar anesthesia to predict post-lumbar hypotension

目的 探讨腰麻前超声检测腰麻前下腔静脉塌陷指数(CI)、下腔静脉呼气末最大直径与腹主动脉直径比值(IVCe/Ao)联合颈动脉血流量变异度(ΔCBF)水平预测腰麻后低血压的价值。方法 选取2019年5月—2021年5月河北省沧州中西医结合医院行腰麻后择期骨科手术患者200例,根据是否发生低血压分为低血压组、无低血压组。比较两组一般资料、麻醉前CI和IVCe/Ao、ΔCBF,分析麻醉前CI、IVCe/Ao联合ΔCBF与低血压关系及预测腰麻后低血压的价值,采用RR分析不同超声参数患者腰麻后低血压危险度。结果 低血压组麻醉前CI低于无低血压组,IVCe/Ao、ΔCBF高于无低血压组(P<0.05);麻醉前CI、IVCe/Ao及ΔCBF均与腰麻后低血压的发生显著相关(P<0.05);单一参数中,ΔCBF预测腰麻后低血压的受试者工作特征(ROC)曲线下面积(AUC)最大,但仍低于麻醉前CI、IVCe/Ao联合ΔCBF的AUC;CI、IVCe/Ao、ΔCBF高水平患者发生低血压风险分别是低水平患者的0.299、2.909、6.023倍(P<0.05)。结论 麻醉前CI、IVCe/Ao、ΔCBF均与腰麻后低血压发生有关,采用超声检测腰麻前以上参数变化可作为预测腰麻后低血压一种可靠方法,为临床液体管理提供参考。

Objective To investigate the value of pre-lumbar ultrasound detection of the inferior vena cava collapse index(CI)and the ratio of the maximum end-expiratory diameter of the inferior vena cava to the diameter of the abdominal aorta(IVCe/Ao)combined with the level of carotid blood flow variability(ΔCBF)to predict post-lumbar hypotension.Methods Two hundred patients undergoing elective orthopedic surgery after lumbar anesthesia from May 2019 to May 2021 were selected and divided into hypotension group and no hypotension group according to whether they hypotension has occurred.The general data,CI and IVCe/Ao before and 10 min after anesthesia,carotid blood flow(CBF)before and after passive leg raising test(PLR)andΔCBF were compared between the two groups to analyze the relationship between CI before anesthesia,IVCe/Ao combined withΔCBF and hypotension and the value of predicting hypotension after lumbar anesthesia,and the risk of hypotension after lumbar anesthesia in patients with different ultrasound parameters was analyzed using RR.Results In the hypotensive group,the pre-anesthetic CI was lower than that of the non-hypotensive group,and IVCe/Ao andΔCBF were higher than that of the non-hypotensive group(P<0.05);pre-anesthetic CI,IVCe/Ao and vCBF were all significantly associated with the occurrence of hypotension after lumbar anesthesia(P<0.05).Among single parameters,the area under curve(AUC)of the receiver operating characteristic(ROC)for predicting postoperative hypotension withΔCBF is the highest,but it is still lower than the AUC of CI,IVCe/Ao combined withΔCBF before anesthesia;the risk of hypotension in patients with high CI,IVCe/Ao andΔCBF levels was 0.299,2.909and 6.023 times higher than those with low levels of CI,IVCe/Ao andΔCBF,respectively(P<0.05).Conclusion CI,IVCe/Ao,andΔCBF are all related to the occurrence of hypotension after lumbar anesthesia,and the use of ultrasound to monitor the changes of these parameters can be a reliable method to predict hypotension after lumbar anesthesia and provide a reference for clinical fluid management.