麻醉前锁骨下静脉/腋静脉超声检查可预测全麻诱导后低血压：前瞻性观察研究
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麻醉前锁骨下静脉/腋静脉超声检查可预测全麻诱导后低血压：前瞻性观察研究
翻译：牛振瑛 编辑：冯玉蓉 审校：曹莹
背景：床旁超声检查下腔静脉已被证明是评估血管内容量状况的可靠工具。锁骨下静脉(SCV)是评估下腔静脉血容量的合理辅助指标。
目的：研究术前SCV或腋静脉的直径和塌陷指数是否可以预测腹腔镜胆囊切除术患者全麻诱导后低血压的发生率。
设计：前瞻性、观察性研究。
单位：三甲教学医院。
受试者：择期进行腹腔镜胆囊切除术的成年患者。
干预措施：麻醉诱导前对SCV或腋静脉(SCV-AV)进行超声评估。
主要观察指标：主要结果是SCV-AV测量值(直径和塌陷指数)与麻醉诱导后的术中低血压(IOH)之间的关系。
结果：发生IOH的患者在自主呼吸(P=0.009)和深吸气时(P=0.002)SCV-AV的塌陷指数较高。在调整混杂变量后，自主呼吸时SCV-AV的塌陷指数不是麻醉诱导后平均动脉压(MAP)下降的显著预测因子(P=0.127)。深吸气时SCV-AV的塌陷指数是一个显著的预测因子(P<0.001)。
结论：深吸气时SCV-AV的塌陷指数是IOH发生和诱导麻醉后MAP下降的重要预测因子。需要对塌陷指数较高的患者进行深入研究来证实我们的发现，然后才能明确推荐SCV-AV塌陷指数应用于临床。
原始文献来源： Choi MH, Chae JS, Lee HJ, et,al.Pre-anaesthesia ultrasonography of the subclavian/infraclavicular axillary vein for predicting hypotension after inducing general anaesthesia ：A prospective observational study[J].Eur J Anaesthesiol 2020 Jun;37(6)DOI:10.1097/EJA.0000000000001192
附图：
Pre-anaesthesia ultrasonography of the subclavian/infraclavicular axillary vein for predicting hypotension after inducing general anaesthesia：A prospective observational study
Abstract
BACKGROUND Bedside sonography of the inferior venacava has been demonstrated to be a reliable tool for assessing intravascular volume status. Subclavian vein (SCV) assessment was proposed as a reasonable adjunct for measuring the inferior vena cava.
OBJECTIVE We examined whether the preoperative diameter and collapsibility index of the SCV or the infraclavicular axillary vein could predict the incidence of hypotension after induction of general anaesthesia in patients undergoing laparoscopic cholecystectomy.
DESIGN Prospective, observational study.
SETTING Tertiary university hospital.
PATIENTS Adults scheduled for laparoscopic cholecystectomy.
INTERVENTION Sonographic evaluation of the SCV or the axillary vein (SCV-AV) before induction of anaesthesia.
MAIN OUTCOME MEASURES The main outcome was the association between the SCV-AV measurements (diameter an collapsibility index) and intra-operative hypotension (IOH) after induction of anaesthesia.
RESULTS Patients who developed IOH had a higher col-lapsibility index of the SCV-AV during spontaneous breathing (P=0.009) and deep inspiration (P=0.002). After adjusting for confounding variables, the collapsibility index of the SCV-AV during spontaneous breathing was not a significant predictor of a decrease in mean arterial blood pressure (MAP) after inducing anaesthesia (P=0.127), whereas the collapsibility index of the SCV-AV during deep inspiration was a significant predictor (P<0.001).
CONCLUSION The collapsibility index of the SCV-AV during deep inspiration was a significant predictor of IOH occurrence and the percentage decrease in MAP after inducing anaesthesia. Further studies in patients with higher collapsibility index are needed to confirm our findings, before the collapsibility index of the SCV-AV can be recommended unequivocally for clinical use.
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