最大下腔静脉直径可预测全身麻醉下接受非心脏手术的高血压患者诱导后低血压：一项前瞻性队列研究。
Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study.
作者信息
Zhang Hanying, Gao Hongguang, Xiang Yuanjun, Li Junxiang
机构信息
Department of Anesthesiology, Third Affiliated Hospital of Chengdu Medical College and Pidu District People's Hospital Chengdu, Chengdu, Sichuan, China.
出版信息
Front Cardiovasc Med. 2022 Oct 4;9:958259. doi: 10.3389/fcvm.2022.958259. eCollection 2022.
BACKGROUND
Inferior vena cava (IVC) ultrasonography is a reliable variable that predicts post-induction hypotension (PIH) in patients undergoing surgery under general anesthesia. However, in patients with hypertension, the predictive performance of ultrasound IVC measurements needs further exploration.
METHODS
This is a prospective cohort study. Adult patients with existing hypertension scheduled to undergo non-cardiac surgery under general anesthesia were eligible. An abdominal ultrasound examination was conducted immediately prior to anesthesia induction (0.03 mg kg midazolam, 0.3 mg kg etomidate, 0.4 μg kg sufentanil, and 0.6 mg kg rocuronium). IVC collapsibility index (IVC-CI) was calculated as (dIVC-dIVC)/dIVC, where dIVC and dIVC represent the maximum and minimum IVC diameters at the end of expiration and inspiration, respectively. PIH was defined as a reduction of mean arterial pressure (MAP) by >30% of the baseline or to <60 mmHg within 10 min after endotracheal intubation. The diagnostic performance of IVC-CI, dIVC, and dIVC in predicting PIH was also examined in a group of normotensive patients receiving non-cardiac surgery under the same anesthesia protocol.
RESULTS
A total of 51 hypertensive patients (61 ± 13 years of age, 31 women) and 52 normotensive patients (42 ± 13 years of age, 35 women) were included in the final analysis. PIH occurred in 33 (64.7%) hypertensive patients and 19 (36.5%) normotensive patients. In normotensive patients, the area under the receiver operating curve (AUC) in predicting PIH was 0.896 (95% confidence interval [CI]: 0.804-0.987) for IVC-CI, 0.770 (95% CI: 0.633-0.908) for dIVC, and 0.868 (95% CI: 0.773-0.963) for dIVC. In hypertensive patients, the AUC in predicting PIH was 0.523 (95% CI: 0.354-0.691) for IVC-CI, 0.752 (95% CI: 0.621-0.883) for dIVC, and 0.715 (95% CI: 0.571-0.858) for dIVC. At the optimal cutoff (1.24 cm), dIVC had 54.5% (18/33) sensitivity and 94.4% (17/18) specificity.
CONCLUSION
In hypertensive patients, IVC-CI is unsuitable for predicting PIH, and dIVC is an alternative measure with promising performance.
CLINICAL TRIAL REGISTRATION
[http://www.chictr.org.cn/], identifier [ChiCTR2000034853].
背景
下腔静脉（IVC）超声检查是预测全身麻醉下手术患者诱导后低血压（PIH）的一个可靠变量。然而，在高血压患者中，超声IVC测量的预测性能需要进一步探索。
方法
这是一项前瞻性队列研究。计划在全身麻醉下接受非心脏手术的成年高血压患者符合条件。在麻醉诱导前（0.03 mg/kg咪达唑仑、0.3 mg/kg依托咪酯、0.4 μg/kg舒芬太尼和0.6 mg/kg罗库溴铵）立即进行腹部超声检查。IVC可塌陷指数（IVC-CI）计算为（dIVC-dIVC）/dIVC，其中dIVC和dIVC分别代表呼气末和吸气末IVC的最大和最小直径。PIH定义为气管插管后10分钟内平均动脉压（MAP）降低>基线的30%或降至<60 mmHg。在一组接受相同麻醉方案的非心脏手术的血压正常患者中，也检查了IVC-CI、dIVC和dIVC预测PIH的诊断性能。
结果
最终分析纳入了51例高血压患者（年龄61±13岁，女性31例）和52例血压正常患者（年龄42±13岁，女性35例）。33例（64.7%）高血压患者和19例（36.5%）血压正常患者发生了PIH。在血压正常患者中，IVC-CI预测PIH的受试者工作特征曲线下面积（AUC）为0.896（95%置信区间[CI]：0.804-0.987），dIVC为0.770（95%CI：0.633-0.908），dIVC为0.868（95%CI：0.773-0.963）。在高血压患者中，IVC-CI预测PIH的AUC为0.523（95%CI：0.354-0.691），dIVC为0.752（95%CI：0.621-0.883），dIVC为0.715（95%CI：0.571-0.858）。在最佳截断值（1.24 cm）时，dIVC的敏感性为54.5%（18/33），特异性为94.4%（17/18）。
结论
在高血压患者中，IVC-CI不适用于预测PIH，dIVC是一种具有良好性能的替代测量方法。
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