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    曹缘, 张梦军, 陈秋冲, 刘金东. 胃肠道手术患者全麻诱导后低血压与静脉塌陷指数的相关性研究[J]. 徐州医科大学学报, 2021, 41(2): 141-145. DOI: 10.3969/j.issn.2096-3882.2021.02.013
    引用本文: 曹缘, 张梦军, 陈秋冲, 刘金东. 胃肠道手术患者全麻诱导后低血压与静脉塌陷指数的相关性研究[J]. 徐州医科大学学报, 2021, 41(2): 141-145. DOI: 10.3969/j.issn.2096-3882.2021.02.013
    The clinical study of the correlation between ultrasound measurement of the inferior vena cava and internal jugular vein collapse index and the occurrence of hypotension in patients with gastrointestinal surgery after general anesthesia[J]. Journal of Xuzhou Medical University, 2021, 41(2): 141-145. DOI: 10.3969/j.issn.2096-3882.2021.02.013
    Citation: The clinical study of the correlation between ultrasound measurement of the inferior vena cava and internal jugular vein collapse index and the occurrence of hypotension in patients with gastrointestinal surgery after general anesthesia[J]. Journal of Xuzhou Medical University, 2021, 41(2): 141-145. DOI: 10.3969/j.issn.2096-3882.2021.02.013

    胃肠道手术患者全麻诱导后低血压与静脉塌陷指数的相关性研究

    The clinical study of the correlation between ultrasound measurement of the inferior vena cava and internal jugular vein collapse index and the occurrence of hypotension in patients with gastrointestinal surgery after general anesthesia

    • 摘要: 目的 探究超声测量颈内静脉塌陷指数(IJVCI)等指标与胃肠道手术患者全身麻醉诱导后低血压发生的相关性,并分析其预测价值.方法 选择全麻行择期胃肠道手术患者112例,年龄45~60岁,ASAⅠ ~Ⅱ级,体重指数(BMI)18~24 kg/cm2.患者入手术室后记录平均动脉压(MAP)与血压基线值,麻醉诱导开始前使用便携式超声测量颈内静脉(IJV)及下腔静脉(IVC)最大和最小内径、计算IJVCI和下腔静脉塌陷指数(IVCCI).诱导开始后至手术开始前每分钟记录1次血压,低血压定义为平均动脉压(MAP)较基线下降20%以上或MAP低于60 mmHg(1 mmHg=0.133 kPa).研究各测量指标与麻醉诱导后低血压的相关性,并通过分析相关指标的敏感度、特异度和受试者特征曲线(ROC)来评估IJVCI、IVCCI在预测全身麻醉诱导后低血压发生中的价值.结果 在112例患者中,有47例发生麻醉诱导后低血压,占42%.在使用血管活性药物或补充容量前后,MAP的下降百分比与IJVCI、IVCCI存在明显的正相关关系,相关系数分别为0.81(P<0.001),0.85(P<0.001);以IJVCI 40.04%为临界值,其曲线下面积(AUC)为0.84(0.75~0.92),敏感度为70.2%、特异度为89.2%;以IVCCI 39.34%为临界值,其曲线下面积(AUC)为0.85(0.77~0.93),敏感度为68.1%、特异度为90.8%.结论 IJVC-CI、IVCCI均与诱导后低血压有显著相关性并能较好地预测麻醉诱导后低血压的发生,两者具有相似的预测效果,有利于术中低血压的预防.

       

      Abstract: objective To explore the correlation between ultrasound measurement of the inferior vena cava and internal jugular vein collapse index and the occurrence of hypotension in patients with gastrointestinal surgery after general anesthesia, and analyze the predictive value. Methods A total of 112 patients undergoing elective gastrointestinal surgery under general anesthesia were recruited. The patients were 45-60 years old, ASA I-III grade, and BMI 18-24 kg/cm2. The mean arterial pressure (MAP) and baseline blood pressure were recorded before operation, portable ultrasound was used to measure the maximum and minimum internal diameters of the internal jugular vein (IJV) and inferior vena cava (IVC), the internal jugular vein collapse index (IJVCI) and the inferior vena cava collapse index (IVCCI) were calculated before the induction of anesthesia. After anesthesia induction, blood pressure was recorded every 1 minute before operation. Hypotension was defined as greater than 20% decrease in MAP from baseline or MAP less than 60 mmHg. The correlation between each measurement index and hypotension after induction of anesthesia was calculated, and the sensitivity, specificity of IJVCI and IVCCI in predicting the occurrence of hypotension after induction of general anesthesia were analyzed through drawing receiver characteristic curve (ROC) of related indicators. Results Among 112 patients, 47 had hypotension after induction of anesthesia, accounting for 42%, and 58% of them had no hypotension. Before and after using vasoactive drugs or supplementing volume, the percentage of decrease in MAP is significantly positively correlated with IJVCI and IVCCI, and the correlation coefficients were 0.81 (P<0.001) and 0.85 (P<0.001), respectively. For predicting hypotension, With 40.04% as the cut-off value of IJVCI, the area under the curve (AUC) is 0.84 (0.75~0.92), the sensitivity is 70.2%, and the specificity is 89.2%. With 39.34% as the cut-off value of IVCCI, the area under the curve (AUC) It is 0.85 (0.77~0.93), the sensitivity is 68.1%, and the specificity is 90.8%. Conclusion Both IJVCCI and IVCCI are significantly correlated with hypotension after induction and can predict the occurrence of hypotension after induction of anesthesia. Both have similar predictive effects and are beneficial to the prevention of intraoperative hypotension

       

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