超声测量下腔静脉变异度对全身麻醉诱导后低血压发生的预测价值

Predictive value of ultrasonic measurement of inferior vena cava in general anesthesia-induced hypotension

目的:探讨下腔静脉超声测量对全麻诱导后低血压的预测价值。方法:选择90例ASA分级Ⅰ~Ⅲ级,在芜湖市第二人民医院全身麻醉下行择期手术的成年患者,麻醉诱导前超声测量下腔静脉最大直径(dIVCmax)、下腔静脉最小直径(dIVCmin),计算下腔静脉变异度(CI),记录患者诱导前基础平均动脉压(MBP)、心率(HR),插管后10 min内的MBP、HR。结果:10例患者的下腔静脉(IVC)扫描不成功。全麻诱导后,36例患者(45.00%)出现低血压。低血压组患者dIVCmax低于非低血压组患者(P<0.05),而CI高于非低血压组(P<0.001)。多因素Logistic回归分析显示,CI增大(OR=1.174)是全麻诱导后低血压的危险因素(P<0.001),而dIVCmax增大(OR=0.033)是全麻诱导后低血压的保护因素(P<0.05)。CI、dIVCmax及联合预测模型的ROC曲线下面积(AUC)分别为0.851、0.654及0.909。结论:术前超声测量CI及dIVCmax预测全麻诱导后低血压具有一定的指导意义,而CI对全麻诱导后低血压的预测价值优于dIVCmax。

Objective:To assess the value of ultrasonic measurement of inferior vena cava in predicting hypotension in patients following general anesthesia induction.Methods:Ninety adult patients(ASA gradeⅠ-Ⅲ)scheduled for elective surgery under general anesthesia in our hospital,were included.All patients underwent preoperative measurement of the maximum and minimum diameter of the inferior vena cava(dIVCmax;dIVCmin)using ultrasound before anesthesia induction.Inferior vena cava variability(CI)was calculated,and the baseline mean arterial pressure(MBP)and heart rate(HR)of the patients before induction,as well as MBP and HR within 10 minutes after intubation,were recorded.Results:Scanning of inferior vena cava(IVC)failed in 10 patients.After general anesthesia induction,36 patients(45.00%)experienced hypotension.In the hypotension group,dIVCmax was lower than in the non-hypotension group(P<0.05),yet the CI was higher(P<0.001).Multivariate logistic regression analysis showed that increment in inferior vena cava variability(OR=1.174)was a risk factor for hypotension after general anesthesia induction(P<0.001),whereas increment in the dIVCmax was a protective factor against hypotension after general anesthesia induction(OR=0.033;P<0.05).The area under the ROC curve for CI,dIVCmax,and the combined prediction model was 0.851,0.654,and 0.909,respectively.Conclusion:Preoperative ultrasound measurement of CI and dIVCmax has certain guiding significance in predicting hypotension after anesthesia induction,and CI can be better predictive value for hypotension after anesthesia induction compared to dIVCmax.