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| 下腔静脉塌陷指数的不同阈值指导输液对预防腰麻后低血压的效果 |
| Effects of different thresholds of inferior vena cava ultrasound-guided volume therapy on prevention arterial hypotension after spinal anesthesia |
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| DOI：10.12089/jca.2018.09.001 |
| 中文关键词: 腰麻后低血压 超声 液体反应性 下腔静脉 塌陷指数 |
| 英文关键词: Hypotension after spinal anesthesia Ultrasound Fluid responsiveness Inferior vena cava Collapsible index |
| 基金项目:南京市科技发展计划项目（201715033）；南京市医学科技发展资金资助（QRX17019）；南京市医学科技发展项目（YKK15088） |
| 作者 | 单位 | E-mail | | 斯妍娜 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | | | 鲍红光 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | hongguang_bao@hotmail.com | | 张晨 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | | | 张媛 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | | | 耿圆 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | | | 景灵 | 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 | |
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| 中文摘要: |
目的 探讨下腔静脉塌陷指数(IVC-CI)的不同阈值指导输液对预防腰麻后低血压的效果。
方法 选择择期实施腰麻的手术患者60例, 男34例，女26例, 年龄 18～65岁, BMI 18～25 kg/m2, ASA Ⅰ或 Ⅱ 级。所有患者按随机数字表法分为三组: 对照组（C组）、下腔静脉塌陷指数指导输液方案1组(IVC-1组)和2组(IVC-2组)。腰麻前对照组不进行超声检查和液体预补充。IVC-1 组或 IVC-2组进行下腔静脉超声监测, 分别以IVC-CI超过50％或40％ 为液体反应阳性指导腰麻前输液。液体治疗后侧卧位下实施腰麻, 麻醉平面控制在T6-T8水平, 低血压时给予液体补充, 腰麻后 30 min开始手术。记录腰麻后低血压发生率和血管活性药物使用率, 记录腰麻前输液量和总输液量。
结果 与C组比较, IVC-1组和IVC-2组的腰麻后低血压发生率、血管活性药物使用率明显减少, 腰麻前输液量和总输液量明显增加(P<0.05)；与IVC-1组比较, IVC-2组低血压发生率、血管活性药物使用率明显减少, 腰麻前输液量明显增加(P<0.05)。
结论 IVC-CI阈值50％和40％ 为液体反应性指导腰麻前输液均可有效预防腰麻后低血压。40％阈值效果更佳。 |
| 英文摘要: |
Ojective To investigate effects of different thresholds of inferior vena cava ultrasound-guided volume therapy on preventing post-spinal hypotension.
Methods Sixty patients, 36 males and 26 females, aged 18 - 65 years, BMI 18 - 25 kg/m2, falling into ASA physical status Ⅰ or Ⅱ were recruited and scheduled to undergo lower extremity surgery under subarachnoid block. All patients were randomly divided into three groups (n = 20): control group (group C), group IVC-1 and group IVC-2. Before subarachnoid block, the patients in the control group did not receive ultrasound monitoring and volume therapy. Patients in group IVC-1 or IVC-2 received IVCUS monitoring and subsequent volume therapy when the inferior vena cava Collapsible index (IVC-CI)> 50％ or 40％, defining as fluid responsiveness positive, respectively. Spinal anesthesia was carried out in the lateral position after volume management in all patients. The sensory block was controlled at T6-T8 level. The patients were administrated fluid resuscitation under hypotension condition and received surgery 30 min after spinal anesthesia. The incidence of hypotension and the incidence of vasopressors use were recorded. Fluid infusion volume before spinal anesthesia and total volume of fluid were recorded.
Results Compared with group C, the incidence of hypotension and vasopressors use were decreased, and fluid infusion volume before spinal anesthesia and total volume of fluid were increased in groups IVC-1 and IVC-2 (P < 0.05). Compared with group IVC-1, the incidence of hypotension and vasopressors use were decreased, and fluid infusion volume before spinal anesthesia were increased in group IVC-2 (P < 0.05).
Conclusion IVC-CI threshold of 50% and 40%, defind as fluid respons: veness positive, can effectively prevent hypotension after spinal anethesia. IVCUS-guided fluid administration may prevent postspinal anesthesia hypotension according to the threshold of IVC-CI, 50％ and 40％ defined as fluid responsiveness positive. The effect of 40％ threshold was better than 50％. |
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