全麻诱导前行下腔静脉超声检查可预测麻醉诱导后低血压的发生
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Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction
背景与目的
低血压是全麻诱导后常见的并发症，严重时会发生不良反应。而下腔静脉超声检查是判断血管内容积状态的可靠指标。本研究的目的是讨论术前行下腔静脉超声检查是否能预测全麻诱导后低血压的发生。
方 法
纳入140名ASA分级I至III级，且进行全麻择期手术的成年患者。术前测量下腔静脉的最大直径（dIVCmax）和塌陷率（CI），以及分别记录诱导前和诱导后10分钟的平均血压（MBP）。定义低血压为平均血压（MBP）较诱导前降低超过30%或者平均血压（MBP）低于60mmHg.采用灰区方法和回归分析法进行特征性曲线分析。
结 果
13.5％的患者IVC检查不成功。分析90例患者的资料显示， 诱导后42例患者出现低血压。 曲线下区域（95%置信区间） 的CI为0.90（0.82〜0.95），dIVCmax为0.76。 CI最理想的阈值为43％，dIVCmax为1.8cm。CI的灰色区域为38%到43%，包括12%的患者，而dIVCmax为1.5到2.1厘米，包括59%的患者。 调整后与其他因素相比，发现CI是低血压的独立预测因子，优势比为1.17（1.09〜1.26）。 CI也与MBP降低百分比呈正相关（回归系数= 0.27）。
结 论
术前行下腔静脉超声检查和 CI测量是预测全身麻醉诱导后的低血压发生的可靠指标，其中CI大于43%是其阈值。
原始文献摘要
Zhang J, Critchley L A. Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction[J]. Anesthesiology, 2016, 124(3):580.
Background: Hypotension is a common side effect of general anesthesia induction, and when severe, it is related to adverse outcomes. Ultrasonography of inferior vena cava (IVC) is a reliable indicator of intravascular volume status. This study investigated whether preoperative ultrasound IVC measurements could predict hypotension after induction of anesthesia.
Methods: One hundred four adult patients, conforming to American Society of Anesthesiologists physical status I to III, scheduled for elective surgery after general anesthesia were recruited. Maximum IVC diameter (dIVCmax) and collapsibility index (CI) were measured preoperatively. Before induction, mean blood pressure (MBP) was recorded. After induction, MBP was recorded for 10 min after intubation. Hypotension was defined as greater than 30% decrease in MBP from baseline or MBP less than 60 mmHg. Receiver operating characteristic curve analysis with gray zone approach and regression analyses were used.
Results: IVC scanning was unsuccessful in 13.5% of patients. Data from 90 patients were analyzed. After induction, 42 patients developed hypotension. Areas (95% confidence interval) under the curves were 0.90 (0.82 to 0.95) for CI and 0.76 (0.66 to 0.84) for dIVCmax. The optimal cutoff values were 43% for CI and 1.8 cm for dIVCmax. The gray zone for CI was 38 to 43% and included 12% of patients and that for dIVCmax was 1.5 to 2.1 cm and included 59% of patients. After adjusting for other factors, it was found that CI was an independent predictor of hypotension with the odds ratio of 1.17 (1.09 to1.26). CI was also positively associated with a percentage decrease in MBP (regression coefficient = 0.27).
Conclusions: Preoperative ultrasound IVC CI measurement was a reliable predictor of hypotension after induction of general anesthesia, wherein CI greater than 43% was the threshold.
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