摘要
目的:分析腰麻后发生低血压的影响因素,并探讨超声监测下腔静脉内径变异度(ΔIVC)对其预测的价值。方法:连续收集2019年1-12月广州新海医院收治的拟行腰麻择期骨科手术的患者200例,按随机数字表分为ΔIVC指导输液组(ΔIVC组)和常规输液组(常规组)各100例。比较两组腰麻后低血压发生率、血管活性药物使用情况、补液总量及腰麻前ΔIVC、腰麻前最低血压时HR、每搏量变异度(stroke volume variation,SVV)、心输出量(cardiac output,CO)。采用Logistic回归分析影响腰麻后低血压发生的危险因素。绘制受试者工作特征曲线(ROC)分析ΔIVC对腰麻后低血压发生的预测价值。结果:与常规组比较,ΔIVC组腰麻后低血压发生率及血管活性药物使用率显著较低,补液总量显著更高(P<0.05)。与非低血压组比较,低血压组ΔIVC、HR、SVV水平显著较高(P<0.05),CO水平显著较低(P<0.05)。Logistic分析结果显示,ΔIVC高、HR高、CO低是影响腰麻后低血压发生的独立危险因素(P<0.05)。ΔIVC预测腰麻后低血压发生的曲线下面积为0.938,截断值为40.083%,敏感度和特异度分别为85.70%、93.80%。结论:超声检测ΔIVC指导输液可有效预防腰麻后低血压,ΔIVC高、HR高、CO低是影响腰麻后低血压发生的独立危险因素,有一定临床应用价值。
Objective:To analyze the influencing factors of hypotension after lumbar anesthesia and to explore the prediction value of ultrasonic monitoring of variation of inferior vena cava inner diameter (ΔIVC) for it.Method:A total of 200 patients undergoing elective orthopedic surgery under lumbar anesthesia admitted to Guangzhou Xinhai Hospital from January to December 2019 were consecutively collected.According to the random number table,they were divided into ΔIVC guided infusion group (ΔIVC group) and routine infusion group (routine group) with 100 cases each.The incidence of hypotension after lumbar anesthesia,the use of vasoactive drugs and the total amount of fluid,ΔIVC before lumbar anesthesia,heart rate (HR),stroke volume variation (SVV) and cardiac output (CO) at lowest blood pressure before lumbar anesthesia were compared between the two groups.Logistic regression was used to analyze the risk factors of hypotension after lumbar anesthesia.Receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of ΔIVC for hypotension after lumbar anesthesia.Result:Compared with the routine group,the incidence of hypotension after lumbar anesthesia and the use of vasoactive drugs in the ΔIVC group were significantly lower,and the total amount of fluid rehydration was significantly higher (P<0.05).Compared with the non-hypotensive group,the levels of ΔIVC,HR and SVV in the hypotensive group were significantly higher (P<0.05),and the level of CO was significantly lower (P<0.05).Logistic analysis showed that high ΔIVC,high HR and low CO were independent risk factors for hypotension after lumbar anesthesia (P<0.05).The area under the curve of ΔIVC predicting hypotension occurred after lumbar hemp was 0.938,and the cutoff value was 40.083%,sensitivity and speciality were 85.70% and 93.80% respectively.Conclusion:Ultrasound detection of ΔIVC can effectively prevent hypotension after lumbar anesthesia,and high ΔIVC,high HR and low CO are independent risk factors for hypotension after lumbar anesthesia,which have certain clinical application value.
作者
马俭发
MA Jianfa(Guangzhou Xinhai Hospital,Guangzhou 510000,China)
出处
《中外医学研究》
2022年第27期163-167,共5页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
超声
下腔静脉内径变异度
腰麻后低血压
预防效果
Ultrasound
Variation of inferior vena cava inner diameter
Hypotension after lumbar anesthesia
Preventive effect
