Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania.
Department of Orthopaedics and Traumatology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania.
Medicina (Kaunas). 2018 Jul 12;54(3):49. doi: 10.3390/medicina54030049.
: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. : 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points. : There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients ( > 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was <0.7, > 0.05. : Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery.
低血压和心动过缓是椎管内麻醉（SA）对心血管系统最常见的血液动力学障碍和副作用。SA 引起的交感神经去神经支配导致外周血管扩张和中央血容量重新分布，可能导致回心血量减少。本研究旨在评估在择期膝关节置换手术中自主呼吸患者的 SA 期间下腔静脉塌陷指数（IVC-CI）的变化，以预测术中低血压和心动过缓的表现。
本前瞻性研究纳入了 60 例性别不限、ASA 身体状况 I 或 II 级、无临床显著心血管疾病的患者，在 SA 下行择期膝关节置换手术。在仰卧位时使用超声设备测量吸气和呼气时的下腔静脉（IVCin、IVCex）直径，分别在 SA 前和 SA 后即刻、15 分钟、30 分钟和 45 分钟进行测量。同时收集心率以及收缩压、舒张压和平均动脉血压。在基线和接下来的四个时间点测量参数。
与基线和其他时间点相比，低血压患者和非低血压患者、心动过缓患者和非心动过缓患者的 IVCin、IVCex 和 IVC-CI 均无显著变化（>0.05）。IVC 直径的变化不能预测 SA 期间的低血压和/或心动过缓：在所有测量点的 IVC-CI 曲线下面积（AUC）的接受者操作特征（ROC）曲线均<0.7，>0.05。
在自主呼吸的择期膝关节置换手术患者中，IVC 直径的减小和 IVC-CI 的增加不能预测 SA 期间的低血压和心动过缓。
