天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (2): 179-184.doi: 10.11958/20202638

• 临床研究 • 上一篇    下一篇

下腔静脉塌陷指数对老年患者腰麻后低血压的预测价值 #br#

张钰，樊世文，殷姜文，翟晶雯，葛明月，秦新磊，代志刚
  

  1. 新疆石河子大学医学院第一附属医院麻醉科（邮编832000）

  • 收稿日期:2020-09-21 修回日期:2020-12-08 出版日期:2021-02-15 发布日期:2021-02-02
  • 通讯作者: 张钰 E-mail:2455645947@qq.com
  • 基金资助:
    石河子大学医学院第一附属医院青年基金项目

The predictive effect of inferior vena cava collapsibility index on postspinal anesthesia hypotension in elderly patients #br#

ZHANG Yu, FAN Shi-wen, YIN Jiang-wen, ZHAI Jing-wen, GE Ming-yue, QIN Xin-lei, DAI Zhi-gang #br#   

  • Received:2020-09-21 Revised:2020-12-08 Published:2021-02-15 Online:2021-02-02
  • Contact: Yu Zhang E-mail:2455645947@qq.com

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摘要： 目的探讨下腔静脉塌陷指数（IVC-CI）对老年患者腰麻后低血压（PSAH）的预测价值以及术前合并高血
压病是否影响IVC-CI对PSAH的预测。 方法选择择期行腰麻（SA）下手术的老年患者163例，根据术前是否临床
确诊高血压病分为合并高血压病组（H组）和未合并高血压病组（N组），2组再根据腰麻后30 min内是否发生低血压
分为低血压组（D组）和未发生低血压组（F组）。分别在SA前、SA后超声测量腔静脉直径（dIVC）最大值（dIVCmax）和
IVC-CI。记录 SA 前和 SA 后 30 min 内收缩压（SBP）、平均动脉压（MAP）、心率（HR）。 结果49 例（30.1%）发生
PSAH。H组患者年龄、体质量指数（BMI）、腰围、SBP、MAP、HR基线值、PSAH发生率明显高于N组患者（P＜0.05）。
D组SA前、后IVC-CI均明显大于F组（P＜0.01）。N组SA前、后IVC-CI与SA后30 min内最低SBP和MAP呈负相关
（P＜0.01）。H组SA前、后IVC-CI与SA后30 min内最低SBP和MAP呈负相关（P＜0.01）。SA前和SA后IVC-CI预
测PSAH的ROC曲线下面积（AUC）明显大于SA前、后dIVCmax （P＜0.01）。 结论SA前和SA后IVC-CI均可以预测术
前合并、未合并高血压病老年患者PSAH的发生，可作为一种无创的预测老年患者PSAH的方法。

关键词: 腔静脉, 下, 低血压, 麻醉, 脊椎, ROC曲线, 下腔静脉塌陷指数, 老年患者

Abstract: Objective To investigate the predictive effect of ultrasound measurement of inferior vena cava
collapsibility index (IVC-CI) on postspinal anesthesia hypotension (PSAH) in elderly patients and whether preoperative
hypertension affects IVC-CI predictive value of PSAH. MethodsA total of 163 elderly patients undergoing elective
surgery under spinal anesthesia (SA) were enrolled in this study. According to the preoperative diagnosis of hypertension,
patients were divided into patients with hypertension group (H group) and patients without hypertension group (N group).
Then according to the occurrence of PSAH during 30 min after SA, the two group were subdivided into hypotension group (D
group) and non-hypotension group (F group). The maximum inferior vena cava diameters (dIVCmax) and IVC-CI were
measured before and after SA. The systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR) were
recorded before SA and 30 min after SA. Results There were 49 patients (30.1%) had hypotension after SA. The baseline
values of age, body mass index (BMI), waist circumference, incidence of PSAH, SBP, MAP and HR were significantly higher
in group H than those in group N (P＜0.05). Before SA and after SA, dIVCmax was significantly smaller in group D than that of
group F (P＜0.05). Before SA and after SA, IVC-CI was significantly greater in group D than that of group F (P＜0.01).
Before SA and 30 min after SA, IVC-CI was negatively correlated with the lowest SBP and MAP in N group (P＜0.01). In H
group, before SA and 30 min after SA, IVC-CI was negatively correlated with the lowest SBP and MAP (P＜0.01). Before
and after SA, the area under ROC curve (AUC) of PSAH predicted by IVC-CI was significantly larger than that of dIVCmax
(P＜0.01). ConclusionBefore and after spinal anaethesia, IVC-CI can predict the occurrence of PSAH of the elderly
patients with hypertension, and which can be used as a noninvasive method for predicting PSAH in the elderly patients.

Key words: vena cava, inferior, hypotension, anesthesia, spinal, ROC curve, inferior vena caval collapsibility index,
elderly patients

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