术前休克指数与非择期剖宫产脊麻后低血压的相关性：一项前瞻性队列研究。
Association between preoperative shock index and hypotension after spinal anesthesia for non-elective cesarean section: a prospective cohort study.
机构信息
Department of Anesthesia, Bharatpur Hospital, Bharatpur, Nepal.
Department of Anesthesiology & Critical Care Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
出版信息
BMC Anesthesiol. 2024 Oct 23;24(1):383. doi: 10.1186/s12871-024-02766-5.
BACKGROUND
Shock index (SI) is calculated as heart rate divided by systolic blood pressure. In the obstetric population, SI of ≥ 0.9 is associated with maternal adverse outcomes. Our primary aim was to investigate the association between SI and post-spinal hypotension in non-elective cesarean section.
METHODS
In this prospective, observational study, term parturient of ASA physical status II, and urgency categories 2 and 3, undergoing non-elective cesarean section with spinal anesthesia were enrolled. We performed univariable and multivariable logistic regression to explore the association between baseline SI (categorized as < 0.9 and ≥ 0.9) and hypotension after spinal anesthesia. The diagnostic ability of the baseline SI to predict post-spinal hypotension was assessed using ROC (receiver operating characteristics) curves.
RESULTS
Three hundred forty-two parturient were recruited, and among them, 335 were analyzed. One hundred fifty-five (46.27%) parturients developed post-spinal hypotension, and 114 (34.03%) reported post-delivery hypotension. Preoperative SI (adjusted odds ratio [AOR], 2.77; 95% CI, 1.15-6.66; p = 0.023) and thoracic sensory block height > 4 (AOR, 2.33; 95%CI, 1.14-4.76; p = 0.020) were associated with post-spinal hypotension. Preoperative SI (AOR, 4.34; 95%CI, 1.72-10.94; p = 0.002) and anxiety (AOR,1.22; 95%CI, 1.06-1.40; p = 0.004) were associated with post-delivery hypotension. Area under the ROC curve for SI alone in predicting hypotension before and after delivery was 0.53 (95%CI 0.49-0.57) and 0.56 (95%CI 0.51-0.60) respectively. However, the model performance as reflected by ROC curve for the multivariable logistic regression analysis was 0.623 for post-spinal hypotension and 0.679 for post-delivery hypotension, respectively.
CONCLUSION
In parturients undergoing non-elective cesarean section, baseline SI ≥ 0.9 was associated with post-spinal and post-delivery hypotension. While the SI alone showed limited predictive power for post-spinal and post-delivery hypotension, integrating it with other risk factors improved the model's predictive ability.
TRIAL REGISTRATION
Registration number: NCT04692870. Date of registration: 05/01/2021. Website: https://clinicaltrials.gov .
背景
休克指数（SI）是心率除以收缩压的比值。在产科人群中，SI 值≥0.9 与产妇不良结局相关。我们的主要目的是研究 SI 与非择期剖宫产术后脊髓麻醉后低血压之间的关系。
方法
在这项前瞻性、观察性研究中，纳入 ASA 身体状况 II 级和紧急程度 2 级和 3 级的足月产妇，行非择期剖宫产术并接受脊髓麻醉。我们进行了单变量和多变量逻辑回归分析，以探讨基线 SI（分类为<0.9 和≥0.9）与脊髓麻醉后低血压之间的关系。使用 ROC 曲线评估基线 SI 预测脊髓麻醉后低血压的诊断能力。
结果
共纳入 342 名产妇，其中 335 名进行了分析。155 名（46.27%）产妇发生了脊髓麻醉后低血压，114 名（34.03%）产妇发生了产后低血压。术前 SI（调整后的优势比 [AOR]，2.77；95%CI，1.15-6.66；p=0.023）和胸段感觉阻滞高度>4（AOR，2.33；95%CI，1.14-4.76；p=0.020）与脊髓麻醉后低血压相关。术前 SI（AOR，4.34；95%CI，1.72-10.94；p=0.002）和焦虑（AOR，1.22；95%CI，1.06-1.40；p=0.004）与产后低血压相关。SI 单独预测分娩前后低血压的 ROC 曲线下面积分别为 0.53（95%CI 0.49-0.57）和 0.56（95%CI 0.51-0.60）。然而，多变量逻辑回归分析的 ROC 曲线反映的模型性能分别为脊髓麻醉后低血压的 0.623 和产后低血压的 0.679。
结论
在接受非择期剖宫产术的产妇中，基线 SI≥0.9 与脊髓麻醉后和产后低血压相关。虽然 SI 单独对脊髓麻醉后和产后低血压的预测能力有限，但将其与其他危险因素相结合可以提高模型的预测能力。
试验注册
注册号：NCT04692870。注册日期：2021 年 5 月 1 日。网址：https://clinicaltrials.gov。
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