摘要
目的探讨颈动脉校正血流时间(FTc)和HR对老年患者蛛网膜下腔阻滞(腰麻)后低血压的预测价值。方法选择择期于腰麻下行髋、膝关节置换术的老年患者40例,男21例,女19例,年龄≥65岁,BMI 18.5~25.0 kg/m^(2),ASAⅡ或Ⅲ级。根据患者腰麻后仰卧位15 min内是否发生低血压分为两组:低血压组(H组)和非低血压组(N组)。腰麻前使用超声测量右侧颈总动脉FTc基线值并记录SBP、DBP、MAP、HR基线值。采用多因素Logistic回归分析老年患者腰麻后低血压的影响因素,绘制基线FTc和HR的受试者工作特征(ROC)曲线并计算曲线下面积(AUC),评价基线FTc和HR的预测价值。结果腰麻后有17例(43%)患者发生低血压。H组年龄明显大于N组,ASAⅢ级、合并高血压比例明显高于N组(P<0.05)。多因素Logistic回归分析结果显示,基线FTc是腰麻后低血压的独立影响因素(P<0.05)。基线FTc的AUC为0.884,截断值为≤323.4 ms,敏感性为82.6%,特异性为94.1%;基线HR的AUC为0.850,截断值为≥80.5次/分,敏感性为82.4%,特异性为86.1%。基线FTc与SBP最大降低幅度呈中度负相关(r=-0.494),基线HR与SBP最大降低幅度呈中度正相关(r=0.573)。结论基线颈动脉FTc和HR对于老年患者腰麻后低血压具有一定的预测效果,且基线FTc的敏感性和特异性更高。
Objective To explore the predictive value of carotid artery corrected flow time(FTc) and heart rate(HR) in elderly patients with hypotension after subarachnoid block(spinal anesthesia). Methods Forty elderly patients, 21 males and 19 females, aged ≥ 65 years, BMI 18.5-25.0 kg/m^(2), ASA physical status Ⅱ or Ⅲ, who underwent hip and knee arthroplasty under spinal anesthesia were selected. According to whether hypotension occurred in supine 15 minutes after spinal anesthesia, the patients were divided into two groups: hypotension group(group H) and non-hypotension group(group N). Before spinal anesthesia, the baseline FTc of right common carotid artery was measured under ultrasound, and the baseline values of SBP, DBP, MAP, and HR were recorded. Multivariate logistic regression was used to analyze the influencing factors of hypotension in elderly patients after spinal anesthesia. The receiver operating characteristic(ROC) curves of baseline FTc and HR were drawn and the area under the curve(AUC) was calculated to evaluate the predictive value. Results Hypotension occurred in 17 patients(43%) after spinal anesthesia. The age and proportion of patients with hypertension and ASA physical status Ⅲ patients in group H were higher than those in group N(P < 0.05). Multivariate logistic regression showed that baseline FTc was an independent factor affecting hypotension, the AUC of baseline FTc was 0.884(truncation value ≤ 323.4 ms, sensitivity 82.6%, specificity 94.1%), the AUC of baseline HR was 0.850(truncation value ≥ 80.5 beats/minute, sensitivity 82.4%, specificity 86.1%). There was a low negative correlation between the maximum decrease of SBP and baseline FTc(r =-0.494), and a moderate positive correlation between the maximum decrease of SBP and baseline HR(r = 0.573). Conclusion Baseline carotid artery FTc and HR can predict hypotension in elderly patients after spinal anesthesia, and baseline FTc has a higher sensitivity and specificity.
作者
董慧慧
耿智隆
张银花
刘伟娇
路晓东
杨永涛
DONG Huihui;GENG Zhilong;ZHANG Yinhua;LIU Weijiao;LU Xiaodong;YANG Yongtao(Department of Anesthesiology,the Second Clinical Medical College,Lanzhou University,Lanzhou 730030,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2022年第6期608-612,共5页
Journal of Clinical Anesthesiology
