Department of Anesthesiology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation, Cangzhou, China.
Basic Medical College, Hebei Medical University, Shijiazhuang, Hebei, China.
Anaesthesiologie. 2024 Nov;73(11):735-742. doi: 10.1007/s00101-024-01468-4. Epub 2024 Oct 9.
This study aimed to identify risk factors associated with hypotension in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia.
A total of 200 patients (50-75 years of age) who underwent elective TKA under spinal anesthesia between October 2023 and January 2024 were enrolled. Patients were divided into two groups (hypotensive and nonhypotensive) depending on the occurrence of postspinal anesthesia hypotension (PSAH). Patient characteristics (age, sex, body mass index, and medical history), blood pressure, heart rate, and ultrasound data before anesthesia were documented. Multivariate logistic regression models were used to determine risk factors for hypotension after spinal anesthesia. Furthermore, a nomogram was constructed according to independent predictive factors. The area under the curve (AUC) and calibration curves were employed to assess the performance of the nomogram.
In total, 175 patients were analyzed and 79 (45.1%) developed PSAH. Logistic regression analysis revealed that variability of the inferior vena cava (odds ratio, OR, 1.147; 95% confidence interval, CI: 1.090-1.207; p < 0.001) and systolic arterial blood pressure (SABP, OR 1.078; 95% CI: 1.043-1.115; p < 0.001) were independent risk factors for PSAH. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the inferior vena cava collapsibility index (IVCCI) and SABP alone were 0.806 and 0.701, respectively, while the AUC of both combined was 0.841. Specifically, an IVCCI of > 37.5% and systolic arterial blood pressure of > 157 mm Hg were considered threshold values. Furthermore, we found that the combination had a better predictive value with higher AUC value, sensitivity, and specificity than the index alone. The nomogram model and calibration curves demonstrated the satisfactory predictive performance of the model.
Elevated preoperative systolic arterial blood pressure and a higher IVCCI were identified as independent risk factors for hypotension in patients receiving spinal anesthesia, which may help guide personalized treatment.
本研究旨在确定脊髓麻醉下全膝关节置换术（TKA）患者发生低血压的相关风险因素。
共纳入 2023 年 10 月至 2024 年 1 月期间接受脊髓麻醉下择期 TKA 的 200 例患者（年龄 50-75 岁）。根据脊髓麻醉后低血压（PSAH）的发生情况，将患者分为低血压组和非低血压组。记录患者特征（年龄、性别、体重指数和病史）、麻醉前血压、心率和超声数据。采用多变量逻辑回归模型确定脊髓麻醉后低血压的危险因素。此外，根据独立预测因素构建列线图。采用曲线下面积（AUC）和校准曲线评估列线图的性能。
共分析了 175 例患者，其中 79 例（45.1%）发生了 PSAH。Logistic 回归分析显示，下腔静脉变异度（比值比，OR，1.147；95%置信区间，CI：1.090-1.207；p<0.001）和收缩压（OR，1.078；95%CI：1.043-1.115；p<0.001）是 PSAH 的独立危险因素。受试者工作特征（ROC）曲线分析显示，下腔静脉可塌陷指数（IVCCI）和收缩压单独的 AUC 分别为 0.806 和 0.701，两者联合的 AUC 为 0.841。具体而言，IVCCI>37.5%和收缩压>157mmHg 被认为是阈值。此外，我们发现，与单独指标相比，联合指标具有更高的 AUC 值、敏感性和特异性，预测价值更好。列线图模型和校准曲线表明，该模型具有良好的预测性能。
术前收缩压升高和较高的 IVCCI 是脊髓麻醉患者发生低血压的独立危险因素，可能有助于指导个体化治疗。
