改良被动抬腿致锁骨下静脉直径变化的麻醉前超声监测可预测全身麻醉后低血压的发生：一项前瞻性观察研究。

Pre-anesthesia ultrasound monitoring of subclavian vein diameter changes induced by modified passive leg raising can predict the occurrence of hypotension after general anesthesia: a prospective observational study.

机构信息

Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian, China.

The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fujian, China.

出版信息

BMC Anesthesiol. 2023 Jan 30;23(1):35. doi: 10.1186/s12871-023-01989-2.

DOI:10.1186/s12871-023-01989-2

PMID:36710335

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9885696/

Abstract

BACKGROUND

Perioperative hypotension increases postoperative complication rates and prolongs postoperative recovery time. Whether Passive Leg Raising test (PLR) and Subclavian Vein Diameter (DSCV) can effectively predict post-anesthesia hypotension remains to be tested. This study aimed to identify specific predictors of General Anesthesia (GA)induced hypotension by measuring DSCV in the supine versus PLR position.

METHODS

A total of 110 patients who underwent elective gynecological laparoscopic surgery under general anesthesia, were enrolled in this study. Before anesthesia, DSCV and theCollapsibility Index of DSCV(DSCV-CI) were measured by ultrasound, and the difference in maximal values of DSCV between supine and PLR positions was calculated, expressed as ΔDSCV. Hypotension was defined as Mean Blood Pressure (MBP) below 60mmhg or more than 30% below the baseline. Patients were divided into two groups according to the presence (Group H) or absence (Group N) of postanesthesia hypotension. The area under the receiver operating characteristic curve (ROC) and logistic regression analyses were used to evaluate the predictability of DSCV and other parameters for predicting preincision hypotension.

RESULTS

Three patients were excluded due to unclear ultrasound scans, resulting in a total of 107 patients studied. Twenty-seven (25.2%) patients experienced hypotension. Area under the ROC curve of ΔDSCV was 0.75 (P < 0.001) with 95% confidence interval (0.63-0.87), while DSCV and DSCV-CI were less than 0.7. The odds ratio (OR)of ΔDSCV was 1.18 (P < 0.001, 95%CI 1.09-1.27) for predicting the development of hypotension. ΔDSCV is predictive of hypotension following induction of general anesthesia.

CONCLUSIONS

ΔDSCV has predictive value for hypotension after general anesthesia.

TRIAL REGISTRATION

The trial was registered in the Chinese Clinical Trial Registry on 04/10/2021.

摘要

背景

围手术期低血压会增加术后并发症的发生率并延长术后恢复时间。被动抬腿试验（PLR）和锁骨下静脉直径（DSCV）是否能有效预测麻醉后低血压仍有待检验。本研究旨在通过测量仰卧位与 PLR 位时的 DSCV，确定全身麻醉（GA）诱导性低血压的具体预测指标。

方法

本研究共纳入 110 例行全身麻醉下择期妇科腹腔镜手术的患者。在麻醉前，通过超声测量 DSCV 和 DSCV collapsibility index（DSCV-CI），计算仰卧位与 PLR 位时 DSCV 的最大差值，以ΔDSCV 表示。低血压定义为平均血压（MBP）低于 60mmHg 或比基础值低 30%以上。根据麻醉后是否发生低血压，将患者分为两组：发生组（Group H）和未发生组（Group N）。使用受试者工作特征曲线（ROC）下面积和 logistic 回归分析评估 DSCV 及其他参数预测切皮前低血压的能力。

结果

因超声图像不清晰，有 3 例患者被排除，最终共有 107 例患者纳入研究。27 例（25.2%）患者发生低血压。ΔDSCV 的 ROC 曲线下面积为 0.75（P<0.001），95%置信区间（0.63-0.87），而 DSCV 和 DSCV-CI 小于 0.7。ΔDSCV 预测低血压发生的比值比（OR）为 1.18（P<0.001，95%CI 1.09-1.27）。ΔDSCV 可预测全麻诱导后低血压的发生。