腋静脉锁骨下径和塌陷指数与老年胃肠手术全身麻醉诱导性低血压的相关性：一项观察性研究。

Association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational study.

机构信息

Department of Anesthesiology, Affiliated Huaian No.1 Hospital of Nanjing Medical University, 223300, Huaian, Jiangsu, China.

Department of Anesthesiology, Affiliated Jinling Hospital, Medical School, Nanjing University, 210002, Nanjing, Jiangsu, China.

出版信息

BMC Anesthesiol. 2023 Oct 9;23(1):340. doi: 10.1186/s12871-023-02303-w.

DOI:10.1186/s12871-023-02303-w

PMID:37814204

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10561445/

Abstract

BACKGROUND

The collapse index of inferior Vena Cava (IVC) and its diameter are important predictive tools for fluid responsiveness in patients, especially critically ones. The collapsibility of infraclavicular axillary vein (AXV) can be used as an alternative to the collapsibility of IVC (IVC-CI) to assess the patient's blood volume.

METHODS

A total of 188 elderly patients aged between 65 and 85 years were recruited for gastrointestinal surgery under general anesthesia. Ultrasound measurements AXV and IVC were performed before induction of general anesthesia. Patients were grouped in accordance to the hypotension after induction. ROC curves were used to analyze the predictive value of ultrasound measurements of AXV and IVC for hypotension after induction of anesthesia. Pearson linear correlation was used to assess the correlation of ultrasound measurements and decrease in mean arterial blood pressure (MAP).

RESULTS

The maximum diameter of AXV(dAXV) and the maximum diameter of IVC (dIVC) were not related to the percentage decrease in MAP; the collapsibility of AXV (AXV-CI) and IVC-CI were positively correlated with MAP changes (correlation coefficients:0.475, 0.577, respectively, p < 0.001). The areas under the curve (AUC) was 0.824 (0.759-0.889) for AXV-CI, and 0.874 (0.820-0.928) for IVC-CI. The optimal threshold for AXV-CI was 31.25% (sensitivity 71.7%, specificity 90.1%), while for IVC-CI was 36.60% (sensitivity 85.9%, specificity 79.0%). Hypotension and down-regulation of MAP during induction can be accurately predicted by AXV-Cl after correction for confounding variables.

CONCLUSION

Infraclavicular axillary vein diameter has no significant correlation with postanesthesia hypotension, whereas AXV-CI may predict postanesthesia hypotension during gastrointestinal surgery of the elderly.

TRIAL REGISTRATION

This study was registered in the Clinical Trial Registry of China on 05/06/2022 (ChiCTR2200060596).

摘要

背景

下腔静脉（IVC）塌陷指数及其直径是预测患者液体反应性的重要工具，尤其是重症患者。锁骨下腋静脉（AXV）的塌陷度可以作为评估患者血容量的 IVC 塌陷度（IVC-CI）的替代指标。

方法

共纳入 188 例年龄在 65-85 岁之间的择期全身麻醉下胃肠手术患者。在全身麻醉诱导前进行超声测量 AXV 和 IVC。根据麻醉诱导后低血压的情况将患者分组。使用 ROC 曲线分析超声测量 AXV 和 IVC 对麻醉诱导后低血压的预测价值。采用 Pearson 线性相关分析评估超声测量值与平均动脉压（MAP）下降的相关性。

结果

AXV 的最大直径（dAXV）和 IVC 的最大直径（dIVC）与 MAP 下降百分比无关；AXV 的塌陷度（AXV-CI）和 IVC-CI 与 MAP 变化呈正相关（相关系数分别为 0.475 和 0.577，均 P<0.001）。AXV-CI 的曲线下面积（AUC）为 0.824（0.759-0.889），IVC-CI 的 AUC 为 0.874（0.820-0.928）。AXV-CI 的最佳阈值为 31.25%（灵敏度 71.7%，特异性 90.1%），IVC-CI 的最佳阈值为 36.60%（灵敏度 85.9%，特异性 79.0%）。在排除混杂因素后，AXV-Cl 可以准确预测诱导期间的低血压和 MAP 下调。