Harde Minal J, Ranale Prashant B, Fernandes Sarita
Department of Anaesthesiology, Topiwala National Medical College & B.Y.L. Nair Ch.Hospital, Mumbai Central Mumbai, Maharashtra, India.
J Anaesthesiol Clin Pharmacol. 2024 Jan-Mar;40(1):37-42. doi: 10.4103/joacp.joacp_178_22. Epub 2023 Jan 12.
It is important to predict and prevent post-spinal hypotension in lower segment cesarean section (LSCS). Peripheral vascular tone can be monitored as a perfusion index (PI) from a pulse oximeter. We aimed to study baseline PI as a predictor of post-spinal hypotension in LSCS.
Prospective observational study conducted in a tertiary care teaching public hospital on patients posted for elective LSCS under spinal anesthesia. Baseline PI and hypotension were compared. A receiver operating characteristic (ROC) curve was plotted and data were analyzed using SPSS version 20.
Among 90 females, 43 (47.8%) had a PI ≤3.5 and 47 (52.2%) had a PI >3.5. In the PI >3.5 group, 46 (97.9%) females had hypotension and required a high volume of IV fluids, and 29 (61.7%) required vasopressors, and the association with PI was statistically significant with Pearson's Chi-square values of 32.26 and 32.36, respectively ( = 0.001). In the ROC, the area under the curve (AUC) was 0.917, proving baseline PI >2.9 as an excellent classifier ( < 0.0001,95% confidence interval [CI] 0.840-0.965) and can predict hypotension with a sensitivity of 83.08% and specificity of 96.00%.
Baseline PI >3.5 was associated with significant post-spinal hypotension and vasopressor administration in LSCS. We established baseline PI >2.9 can predict post-spinal hypotension with high sensitivity and specificity. PI is simple, quick, and non-invasive and can be used as a predictor for post-spinal hypotension in parturients undergoing LSCS so that prophylactic measures can be considered in at-risk patients for better maternal and fetal outcomes.
预测和预防下段剖宫产术（LSCS）后脊髓性低血压很重要。外周血管张力可通过脉搏血氧仪监测灌注指数（PI）来进行评估。我们旨在研究基线PI作为LSCS后脊髓性低血压的预测指标。
在一家三级护理教学公立医院对接受脊髓麻醉下择期LSCS的患者进行前瞻性观察研究。比较基线PI与低血压情况。绘制受试者工作特征（ROC）曲线，并使用SPSS 20版软件进行数据分析。
90名女性中，43名（47.8%）PI≤3.5，47名（52.2%）PI>3.5。在PI>3.5组中，46名（97.9%）女性出现低血压，需要大量静脉输液，29名（61.7%）需要使用血管升压药，PI与之的关联具有统计学意义，Pearson卡方值分别为32.26和32.36（P = 0.001）。在ROC曲线中，曲线下面积（AUC）为0.917，证明基线PI>2.9是一个优秀的分类指标（P<0.0001，95%置信区间[CI] 0.840 - 0.965），可预测低血压，灵敏度为83.08%，特异度为96.00%。
基线PI>3.5与LSCS后显著脊髓性低血压及血管升压药使用相关。我们确定基线PI>2.9可高灵敏度和特异度地预测脊髓性低血压。PI简单、快速且无创，可作为接受LSCS产妇脊髓性低血压的预测指标，以便对高危患者采取预防措施，改善母婴结局。
