de Boer Esmée C, van Houte Joris, Fernandes Catarina Dinis, Bakkes Tom, Muehlsteff Jens, Bouwman R Arthur, Mischi Massimo
Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands.
Perioper Med (Lond). 2025 Mar 8;14(1):26. doi: 10.1186/s13741-025-00508-w.
The induction of spinal anesthesia is often followed by hypotension, which has been associated with post-operative end-organ damage. A timely prediction of spinal anesthesia-induced hypotension (SAIH) paired with appropriate interventions may reduce the risk of adverse outcomes. This study investigated the value of carotid Doppler ultrasound measurements and clinical variables, both individually and combined, to predict SAIH.
Adult patients who were scheduled for elective surgery under spinal anesthesia were included. Carotid ultrasound imaging and baseline vital sign measurements were performed pre-operatively, well in advance of the induction of spinal anesthesia. The occurrence of hypotension was observed for ten minutes after the induction of spinal anesthesia. Logistic regression models studied linear relationships within the derived set of ultrasound and clinical features, and support vector machine models evaluated nonlinear relationships.
A total of 40 patients were included, and 45% of them developed SAIH. The logistic regression models performed better than the support vector machine models. The best-performing logistic regression model combined carotid ultrasound and clinical features and had a sensitivity of 75 [73-81]%, specificity of 75 [71-81]%, AUROC of 0.81 [0.75-0.95], positive predictive value of 75 [65-81]%, negative predictive value of 75 [71-88]% and F1 score of 0.75 [0.71-0.76]. The key features that were shown to predict SAIH were baseline mean arterial pressure, fasting time, ASA class, and weight.
Combining carotid Doppler ultrasound measurements and clinical variables can predict the occurrence of SAIH.
The study was retrospectively registered at clinicaltrials.gov (NCT06711289) on 2 December 2024.
脊髓麻醉诱导后常出现低血压，这与术后终末器官损伤有关。及时预测脊髓麻醉诱导性低血压（SAIH）并采取适当干预措施可能会降低不良结局的风险。本研究调查了颈动脉多普勒超声测量值和临床变量单独及联合使用对预测SAIH的价值。
纳入计划接受脊髓麻醉下择期手术的成年患者。在脊髓麻醉诱导前很久，于术前进行颈动脉超声成像和基线生命体征测量。在脊髓麻醉诱导后观察十分钟内低血压的发生情况。逻辑回归模型研究了超声和临床特征衍生集中的线性关系，支持向量机模型评估了非线性关系。
共纳入40例患者，其中45%发生了SAIH。逻辑回归模型的表现优于支持向量机模型。表现最佳的逻辑回归模型结合了颈动脉超声和临床特征，其灵敏度为75[73 - 81]%，特异度为75[71 - 81]%，曲线下面积（AUROC）为0.81[0.75 - 0.95]，阳性预测值为75[65 - 81]%，阴性预测值为75[71 - 88]%，F1评分为0.75[0.71 - 0.76]。显示可预测SAIH的关键特征为基线平均动脉压、禁食时间、美国麻醉医师协会（ASA）分级和体重。
结合颈动脉多普勒超声测量值和临床变量可预测SAIH的发生。
该研究于2024年12月2日在clinicaltrials.gov（NCT06711289）进行回顾性注册。
