Gunashekar Satheesh, Kaushal Ashutosh, Kumar Ajit, Gupta Priyanka, Gupta Namrata, C S Pooja
Department of Anaesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Anaesthesia, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Indian J Anaesth. 2024 Apr;68(4):360-365. doi: 10.4103/ija.ija_706_23. Epub 2024 Mar 13.
Short-term hypotension after general anaesthesia can negatively impact surgical outcomes. This study compared the predictive potential of the pleth variability index (PVI), pulse pressure variability (PPV), and perfusion index (PI) for anaesthesia-induced hypotension. This study's primary objective was to evaluate the predictive potential of PI, PVI, and PPV for hypotension.
This observational study included 140 adult patients undergoing major abdominal surgery under general anaesthesia. Mean arterial pressure, heart rate, PVI, PPV, and PI were collected at 1-min intervals up to 20 min post anaesthesia induction. Hypotension was assessed at 5-min and 15-min intervals. Receiver operating characteristic (ROC) curves were plotted to determine the diagnostic performance and best cut-off for continuous variables in predicting a dichotomous outcome. Statistical significance was kept at < 0.05.
Hypotension prevalence within 5 and 15 min of anaesthesia induction was 36.4% and 45%, respectively. A PI cut-off of <3.5 had an area under the ROC curve (AUROC) of 0.647 ( = 0.004) for a 5-min hypotension prediction. The PVI's AUROC was 0.717 ( = 0.001) at cut-off >11.5, while PPV's AUROC was 0.742 ( = 0.001) at cut-off >12.5. At 15 min, PVI's AUROC was 0.615 (95% confidence interval 0.521-0.708, = 0.020), with 54.9% positive predictive value and 65.2% negative predictive value.
PVI, PPV, and PI predicted hypotension within 5 min after general anaesthesia induction. PVI had comparatively higher accuracy, sensitivity, specificity, and positive predictive value than PI and PPV when predicting hypotension at 15 min.
全身麻醉后的短期低血压会对手术结果产生负面影响。本研究比较了脉搏波变异指数（PVI）、脉压变异度（PPV）和灌注指数（PI）对麻醉诱导性低血压的预测潜力。本研究的主要目的是评估PI、PVI和PPV对低血压的预测潜力。
本观察性研究纳入了140例接受全身麻醉下腹部大手术的成年患者。在麻醉诱导后20分钟内，每隔1分钟收集平均动脉压、心率、PVI、PPV和PI。每隔5分钟和15分钟评估一次低血压情况。绘制受试者工作特征（ROC）曲线，以确定连续变量在预测二分结果时的诊断性能和最佳截断值。统计学显著性设定为<0.05。
麻醉诱导后5分钟和15分钟内低血压的发生率分别为36.4%和45%。对于5分钟低血压预测，PI截断值<3.5时，ROC曲线下面积（AUROC）为0.647（P = 0.004）。PVI截断值>11.5时，AUROC为0.717（P = 0.001），而PPV截断值>12.5时，AUROC为0.742（P = 0.001）。在15分钟时，PVI的AUROC为0.615（95%置信区间0.521 - 0.708，P = 0.020），阳性预测值为54.9%，阴性预测值为65.2%。
PVI、PPV和PI可预测全身麻醉诱导后5分钟内的低血压。在预测15分钟时的低血压时，PVI比PI和PPV具有相对更高的准确性、敏感性、特异性和阳性预测值。
