Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou.
Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People's Republic of China.
Int J Surg. 2024 Feb 1;110(2):799-809. doi: 10.1097/JS9.0000000000000863.
Hypotension often occurs following the induction of general anesthesia in elderly patients undergoing surgery and can lead to severe complications. This study assessed the effect of carotid corrected flow time (FTc) combined with perioperative fluid therapy on preventing hypotension after general anesthesia induction in elderly patients.
The prospective cohort study was divided into two parts. The first part (Part I) consisted of 112 elderly patients. Carotid FTc was measured using Color Doppler Ultrasound 5 min before anesthesia induction. Hypotension was defined as a decrease of greater than 30% in systolic blood pressure (SBP) or a decrease of greater than 20% in mean arterial pressure (MAP) from baseline, or an absolute SBP below 90 mmHg and MAP below 60 mmHg within 3 min after induction of general anesthesia. The predictive value of carotid FTc was determined using receiver operating characteristic (ROC) curve. The second part (Part II) consisted of 65 elderly patients. Based on the results in Part I, elderly patients with carotid FTc below the optimal cut-off value received perioperative fluid therapy at a volume of 8 ml/kg of balanced crystalloids (lactated Ringer's solution) in 30 min before induction. The effect of carotid FTc combined with perioperative fluid therapy was assessed by comparing observed incidence of hypotension after induction.
The area under the ROC for carotid FTc to predict hypotension after induction was 0.876 [95% confidence interval (CI) 0.800-0.952, P <0.001]. The optimal cut-off value was 334.95 ms (sensitivity of 87.20%; specificity of 82.20%). The logistic regression analysis revealed that carotid FTc is an independent predictor for post-induction hypotension in elderly patients. The incidence of post-induction hypotension was significantly lower ( P <0.001) in patients with carotid FTc less than 334.95 ms who received perioperative fluid therapy (35.71%) compared to those who did not (92.31%).
Carotid FTc combined with the perioperative fluid therapy could significantly reduce the incidence of hypotension after the induction of general anesthesia in elderly patients.
老年患者在接受手术全麻诱导后常发生低血压，并可能导致严重并发症。本研究评估了颈动脉校正血流时间（FTc）联合围手术期液体治疗预防全麻诱导后老年患者低血压的效果。
前瞻性队列研究分为两部分。第一部分（部分 I）包括 112 例老年患者。麻醉诱导前 5 分钟使用彩色多普勒超声测量颈动脉 FTc。低血压定义为收缩压（SBP）下降大于 30%或平均动脉压（MAP）下降大于 20%，或全麻诱导后 3 分钟内 SBP 绝对低于 90mmHg，MAP 低于 60mmHg。颈动脉 FTc 的预测价值采用接受者操作特征（ROC）曲线确定。第二部分（部分 II）包括 65 例老年患者。根据部分 I 的结果，颈动脉 FTc 低于最佳截断值的老年患者在全麻诱导前 30 分钟内接受 8ml/kg 平衡晶体液（乳酸林格氏液）的围手术期液体治疗。通过比较诱导后低血压的观察发生率来评估颈动脉 FTc 与围手术期液体治疗相结合的效果。
颈动脉 FTc 预测诱导后低血压的 ROC 曲线下面积为 0.876（95%置信区间 0.800-0.952，P<0.001）。最佳截断值为 334.95ms（敏感性 87.20%；特异性 82.20%）。Logistic 回归分析显示，颈动脉 FTc 是老年患者全麻诱导后低血压的独立预测因素。颈动脉 FTc 小于 334.95ms 的患者接受围手术期液体治疗的术后低血压发生率明显较低（P<0.001）（35.71%），而未接受者（92.31%）。
颈动脉 FTc 联合围手术期液体治疗可显著降低老年患者全麻诱导后低血压的发生率。
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