Department of Anesthesiology and Reanimation, Bozok University, Yozgat, Turkey
Turk J Med Sci. 2021 Feb 26;51(1):134-139. doi: 10.3906/sag-1912-132.
BACKGROUND/AIM: Anesthesia-induced hypotension may have negative consequences in geriatric patients. Therefore, predicting hypotension remains an important topic for anesthesiologists. Pleth Variability Index (PVI) measurement provides information about the fluid status and vascular tonus of patients. In this study, the ability of the Pleth Variability Index to predict hypotension after general anesthesia induction was evaluated.
PVI values obtained from pulse oximetry were recorded, in addition to preoperative standard anesthesia monitoring. The correlation between the PVI value and mean arterial pressure (MAP), systolic arterial blood pressure (SAP) changes, and the power of PVI values to predict the incidence of hypotension after anesthesia induction (>20% MAP decrease) was tested.
Eighty patients over 65 years of age who were operated under general anesthesia were included in the study. Hypotension was observed in 20 patients (25%). PVI values were mild and positively correlated with MAP changes (r = 0.195 and P = 0.041). According to receiver operating characteristic (ROC) analysis, the incidence of hypotension increased in patients with PVI values above 15.45%. We also found the following diagnostic results for PVI value for predicting hypotension: P = 0.044 and area under the ROC curve of 0.651 ± 0.073 (95% confidence interval (CI): 0.507–0.794), 40% sensitivity, 80% specificity, a PPV of 40%, an NPV of 80%, a cut-off value of 15.45, a positive likelihood ratio of 2, a negative likelihood ratio of 0.75, and a Youden Index of 0.2.
Predicting hypotension in geriatric patients is an important issue for anesthesiologists. As an easily applicable test, the Pleth Variability Index is useful in predicting MAP reduction in patients. This practical technique can be used routinely in all geriatric patient groups.
背景/目的：麻醉诱导性低血压可能会给老年患者带来负面影响。因此，预测低血压仍然是麻醉师的重要课题。容积脉搏变异指数（PVI）测量可提供有关患者液体状态和血管紧张度的信息。在这项研究中，评估了容积脉搏变异指数预测全身麻醉诱导后低血压的能力。
记录了从脉搏血氧饱和度仪获得的 PVI 值，以及术前标准麻醉监测。测试了 PVI 值与平均动脉压（MAP）、收缩压（SAP）变化之间的相关性，以及 PVI 值预测麻醉诱导后低血压（MAP 降低超过 20%）发生率的能力。
本研究纳入了 80 名 65 岁以上接受全身麻醉手术的患者。20 名患者（25%）出现低血压。PVI 值轻度升高且与 MAP 变化呈正相关（r = 0.195，P = 0.041）。根据接收者操作特征（ROC）分析，PVI 值大于 15.45 的患者发生低血压的概率增加。我们还发现 PVI 值预测低血压的以下诊断结果：P = 0.044，ROC 曲线下面积为 0.651 ± 0.073（95%置信区间（CI）：0.507-0.794），40%敏感性，80%特异性，阳性预测值为 40%，阴性预测值为 80%，截断值为 15.45，阳性似然比为 2，阴性似然比为 0.75，约登指数为 0.2。
预测老年患者的低血压是麻醉师的重要问题。作为一种易于应用的测试，容积脉搏变异指数可用于预测患者 MAP 降低。这种实用技术可常规用于所有老年患者群体。
