Desari Guru C, Jangra Kiran, Arya Virendra K, Regmi Sabina, Aggarwal Ashish, Bhagat Hemant, Panda Nidhi B, Soni Shiv L, Bloria Summit D
Department of Anaesthesia NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India.
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Neurol India. 2025 May 1;73(3):474-479. doi: 10.4103/neurol-india.Neurol-India-D-23-00265. Epub 2025 May 23.
Volume disturbances frequently occur after aneurysmal subarachnoid hemorrhage (a-SAH). Both hypovolemia and hypervolemia are associated with poor outcomes. Hence, we planned this study to determine preoperative volume status using echocardiography.
The primary objective was to determine the incidence of preoperative hypovolemia in a-SAH patients with echocardiography. The secondary objectives include association between hypovolemia and induction hypotension and relative risk, and relative sensitivity and specificity of echocardiographic indices in predicting induction hypotension.
Ninety-eight ASA-I or -II patients, aged 18-65 years, undergoing aneurysmal clipping surgery were included. Hypovolemia was assessed by inferior vena cava (IVC) diameter, IVC collapsibility index in subcostal view, left ventricular end-diastolic area and kissing-papillary sign in parasternal short axis view, and variations in left-ventricular outflow tract velocity-time integral (LVOT-VTI) in apical view. Induction-hypotension was defined as mean arterial pressure <70 mm of Hg until 10 min after induction.
Out of 98 patients, 69 (70%) were hypovolemic and 59 (60%) developed induction hypotension with a relative risk of 2.26. The IVC-Cx and LVOT-VTI were the most sensitive parameters for determining induction hypotension (76% and 91%, respectively). A combination of IVC-Cx and kissing-papillary signs were most reliable for determining induction hypotension (P = 0.010).
We conclude that the incidence of preoperative hypovolemia was 70%, and 60% of patients had induction hypotension. Dynamic parameters including IVC-Cx and VTI-variations are more reliable in predicting induction hypotension. We emphasize that preoperative screening of patients using ultrasound helps identify the hypovolemic patients in the preoperative area.
动脉瘤性蛛网膜下腔出血（a-SAH）后常出现容量紊乱。低血容量和高血容量均与不良预后相关。因此，我们开展本研究以使用超声心动图确定术前容量状态。
主要目的是通过超声心动图确定a-SAH患者术前低血容量的发生率。次要目的包括低血容量与诱导期低血压之间的关联及相对风险，以及超声心动图指标预测诱导期低血压的相对敏感性和特异性。
纳入98例年龄在18至65岁之间、接受动脉瘤夹闭手术的ASA-I或-II级患者。通过下腔静脉（IVC）直径、肋下视图中IVC可塌陷指数、胸骨旁短轴视图中左心室舒张末期面积和亲吻乳头征，以及心尖视图中左心室流出道速度时间积分（LVOT-VTI）的变化来评估低血容量。诱导期低血压定义为诱导后10分钟内平均动脉压<70 mmHg。
98例患者中，69例（70%）为低血容量，59例（60%）出现诱导期低血压，相对风险为2.26。IVC-Cx和LVOT-VTI是确定诱导期低血压最敏感的参数（分别为76%和91%）。IVC-Cx和亲吻乳头征相结合对于确定诱导期低血压最可靠（P = 0.010）。
我们得出结论，术前低血容量的发生率为70%，60%的患者出现诱导期低血压。包括IVC-Cx和VTI变化在内的动态参数在预测诱导期低血压方面更可靠。我们强调，术前使用超声对患者进行筛查有助于在术前区域识别低血容量患者。
