Li Xiaomei, Yang Guangsui, Hao Suwen, Zhu Changhua, Liu Haijian, Zhu Jiang
From the Department of Anesthesiology, The Shanghai Zhoupu Hospital, Shanghai, China.
Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
BMC Anesthesiol. 2025 Sep 1;25(1):440. doi: 10.1186/s12871-025-03295-5.
Atrial fibrillation (AF) is a prevalent arrhythmia, the ineffective contraction of the atria leads to a decrease in effective cardiac output. AF patients are prone to hypotension during anesthesia, especially in the early stages of general anesthesia. We explored whether the inferior vena cava collapsibility index (IVCCI) or the superior vena cava distensibility index (SVCDI) could predict the occurrence of post-induction hypotension (PIH) and early intraoperative hypotension (eIOH) in AF patients.
A total of 77 AF patients undergoing left atrial appendage occlusion under general anesthesia were included in this study. The inferior vena cava was measured before induction and the superior vena cava after induction. The main outcome was the ultrasound measurements of IVCCI and SVCDI in AF patients and their association with hypotension during general anesthesia. Hypotension was classified as the mean arterial pressure (MAP) below 60 mmHg or more than 20% below the baseline level. The correlation between IVCCI, SVCDI and the percentage decrease in MAP was assessed. Receiver operating characteristic (ROC) curves of IVCCI, SVCDI were separately generated to predict PIH and eIOH. Logistic regression was employed to validate the risk factors for PIH and eIOH in AF patients.
AF patients who developed PIH had a significantly higher IVCCI (P < 0.001) and developed eIOH had a significantly higher SVCDI (P < 0.001). ROC curve analysis showed that IVCCI had an accuracy of 85% to predict PIH at a cut-off point more than 34.1% (P < 0.001). SVCDI had an accuracy of 86% to predict eIOH at a cut-off point more than 17.8% (P < 0.001). After adjusting for confounding variables, IVCCI was an independent predictor of PIH (P < 0.001), while SVCDI was an independent predictor of eIOH (P < 0.001).
Preoperative IVCCI > 34.1% indicates a non-invasive predictor of PIH in AF patients; SVCDI > 17.8% suggest a reliable predictor of eIOH in AF patients.
This trial was registered on June 27, 2023 at the China Clinical Trial Center (http://www.chictr.org.cn; No. ChiCTR2300072846).
心房颤动（AF）是一种常见的心律失常，心房无效收缩导致有效心输出量减少。AF患者在麻醉期间容易发生低血压，尤其是在全身麻醉的早期阶段。我们探讨了下腔静脉塌陷指数（IVCCI）或上腔静脉扩张指数（SVCDI）是否可以预测AF患者诱导后低血压（PIH）和术中早期低血压（eIOH）的发生。
本研究共纳入77例在全身麻醉下行左心耳封堵术的AF患者。诱导前测量下腔静脉，诱导后测量上腔静脉。主要观察指标是AF患者的IVCCI和SVCDI超声测量值及其与全身麻醉期间低血压的相关性。低血压定义为平均动脉压（MAP）低于60 mmHg或比基线水平降低20%以上。评估IVCCI、SVCDI与MAP降低百分比之间的相关性。分别生成IVCCI、SVCDI的受试者工作特征（ROC）曲线以预测PIH和eIOH。采用逻辑回归分析验证AF患者PIH和eIOH的危险因素。
发生PIH的AF患者IVCCI显著更高（P < 0.001），发生eIOH的AF患者SVCDI显著更高（P < 0.001）。ROC曲线分析显示，IVCCI在截断点大于34.1%时预测PIH的准确率为85%（P < 0.001）。SVCDI在截断点大于17.8%时预测eIOH的准确率为86%（P < 0.001）。在调整混杂变量后，IVCCI是PIH的独立预测因子（P < 0.001），而SVCDI是eIOH的独立预测因子（P < 0.001）。
术前IVCCI > 34.1%表明是AF患者PIH的无创预测指标；SVCDI > 17.8%提示是AF患者eIOH的可靠预测指标。
本试验于2023年6月27日在中国临床试验中心注册（http://www.chictr.org.cn；注册号：ChiCTR2300072846）。
