Gülaşti Ferdi, Gülaşti Sevil, Sari Sinem
Department of Anesthesiology and Reanimation, Aydin Gynecology and Children's Hospital, Aydin, Türkiye -
Department of Cardiology, Faculty of Medicine, Adnan Menderes University, Aydin, Türkiye.
Minerva Anestesiol. 2023 Apr;89(4):265-272. doi: 10.23736/S0375-9393.22.16711-8. Epub 2022 Oct 25.
Hypotension, which may develop after anesthesia induction, may cause ischemic stroke, myocardial damage, acute kidney injury, and postoperative mortality. Various assessments can be used to predict hypotension. We aimed to test the relationship of tricuspid annular plane systolic movement (TAPSE) with hypotension.
A total of 47 patients aged 18-65 years, who were scheduled for general anesthesia for elective surgery, had ASA I-II, and had no known cardiovascular disease, were included in the study. TAPSE was calculated in an apical four-chamber view by placing an M-mode cursor along the tricuspid annulus, and measuring the longitudinal movement amount in the peak systole. TAPSE was measured 30 minutes before the surgery. The primary objective of the present study was to test the relationship between TAPSE and hypotension because of general anesthesia induction. We accepted hypotension as a decrease of 30% or more from baseline in systolic blood pressure (SBP) in the first 10 minutes following induction or a decrease in mean arterial pressure (MAP) below 60 mmHg.
Statistically significant differences were detected in TAPSE values compared to the hypotension status after general anesthesia induction (P<0.001). The value of TAPSE had an optimal cut-off value of ≤2.48cm for the diagnostic yield of the development of hypotension after the general anesthesia induction. This cut-off value had a sensitivity and specificity of 90.00% and 95.83%.
TAPSE predicted the development of hypotension after general anesthesia induction. Further studies are required to prove the diagnostic accuracy of TAPSE as a predictor of hypotension after general anesthesia induction.
麻醉诱导后可能出现的低血压，可能导致缺血性中风、心肌损伤、急性肾损伤和术后死亡。可采用多种评估方法来预测低血压。我们旨在测试三尖瓣环平面收缩期位移（TAPSE）与低血压之间的关系。
本研究纳入了47例年龄在18 - 65岁之间、计划接受择期手术全身麻醉、美国麻醉医师协会（ASA）分级为I - II级且无已知心血管疾病的患者。通过在心尖四腔视图中沿三尖瓣环放置M型光标，并测量收缩期峰值时的纵向移动量来计算TAPSE。TAPSE在手术前30分钟测量。本研究的主要目的是测试TAPSE与全身麻醉诱导所致低血压之间的关系。我们将低血压定义为诱导后前10分钟内收缩压（SBP）较基线下降30%或更多，或平均动脉压（MAP）降至60 mmHg以下。
与全身麻醉诱导后的低血压状态相比，TAPSE值存在统计学显著差异（P<0.001）。TAPSE值对于全身麻醉诱导后低血压发生的诊断效能，其最佳截断值为≤2.48cm。该截断值的敏感性和特异性分别为90.00%和95.83%。
TAPSE可预测全身麻醉诱导后低血压的发生。需要进一步研究来证实TAPSE作为全身麻醉诱导后低血压预测指标的诊断准确性。
