Hung Kuo-Chuan, Liu Chien-Cheng, Huang Yen-Ta, Wu Jheng-Yan, Chen Jen-Yin, Ko Ching-Chung, Lin Chien-Ming, Hsing Chung-Hsi, Yew Ming, Chen I-Wen
Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan.
Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City 82456, Taiwan.
Diagnostics (Basel). 2023 Aug 3;13(15):2584. doi: 10.3390/diagnostics13152584.
This meta-analysis assessed the predictive efficacy of perfusion index for hypotension following spinal anesthesia (SA) in parturients undergoing elective cesarean section (CS). Electronic databases, including Google Scholar, EMBASE, Cochrane Library, and MEDLINE, were searched from inception to June 2023. The primary outcome was the diagnostic accuracy of the perfusion index in predicting the probability of perioperative hypotension following SA. The review included 12 studies involving 2009 patients, published between 2017 and 2023. The pooled sensitivity and specificity were 0.81 (95% confidence interval (CI) = 0.72-0.87) and 0.75 (95% CI = 0.67-0.82), respectively. Additionally, the pooled area under the curve (AUC) was calculated as 0.84 (95% CI = 0.81-0.87), suggesting a moderate to good accuracy of the diagnostic test. Using Fagan's nomogram plot, the positive likelihood ratio (LR) and negative LR were found to be 3 and 0.26, respectively. The results demonstrated that the perfusion index exhibited an acceptable level of accuracy in predicting perioperative hypotension after spinal anesthesia in parturients undergoing elective CS. These findings highlight the potential value of incorporating a perfusion index as a useful tool for clinicians to integrate into routine clinical practice, which necessitates further large-scale studies for verification.
本荟萃分析评估了灌注指数对择期剖宫产（CS）产妇脊髓麻醉（SA）后低血压的预测效力。检索了包括谷歌学术、EMBASE、考克兰图书馆和MEDLINE在内的电子数据库，检索时间从建库至2023年6月。主要结局是灌注指数预测SA后围手术期低血压概率的诊断准确性。该综述纳入了12项研究，涉及2009例患者，发表时间为2017年至2023年。合并敏感度和特异度分别为0.81（95%置信区间（CI）=0.72-0.87）和0.75（95%CI=0.67-0.82）。此外，计算得出合并曲线下面积（AUC）为0.84（95%CI=0.81-0.87），表明诊断试验准确性中等至良好。使用费根列线图，发现阳性似然比（LR）和阴性LR分别为3和0.26。结果表明，灌注指数在预测择期CS产妇脊髓麻醉后围手术期低血压方面表现出可接受的准确性水平。这些发现凸显了将灌注指数作为一种有用工具纳入临床医生常规临床实践的潜在价值，这需要进一步的大规模研究进行验证。
