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| 上下肢灌注指数预测剖宫产腰-硬联合麻醉后低血压的可行性 |
| Feasibility of perfusion index of the upper and lower limbs as predictors of hypotension after combined epidural-spinal anesthesia in cesarean section |
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| DOI：10.12089/jca.2018.12.006 |
| 中文关键词: 灌注指数 剖宫产 腰-硬联合麻醉 低血压 |
| 英文关键词: Perfusion index Cesarean section Combined spinal-epidural anesthesia Hypotension |
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| 中文摘要: |
目的 探讨上下肢灌注指数(perfusion index, PI)预测剖宫产产妇腰-硬联合麻醉后发生低血压的可行性。
方法 选择行子宫下段剖宫产术患者166例, 年龄20～35岁, BMI 20～40 kg/m2, ASA Ⅰ或Ⅱ级, 禁食6～12 h, 入室后测量上下肢PI基础值, 并快速静脉输注羟乙基淀粉500 ml, 左侧卧位下行腰-硬联合麻醉, 持续监测并记录产妇麻醉前至麻醉后10 min内血压及PI值, 以动脉收缩压下降幅度超过基础值的20％为产妇低血压判定标准,绘制上下肢PI基础值及其差值判断发生低血压的受试者工作特性曲线(ROC), 计算诊断阈值、曲线下面积(AUC)和95％可信区间(CI)。
结果 低血压产妇77例(46.4%),上、下肢PI基础值及其差值评估发生低血压的AUC（95%CI）分别为0.661、0.619、0.876,诊断阈值分别为1.81、0.873、1.094, 判断发生低血压的敏感度分别为0.481、0.883、0.818, 特异度分别为0.798、0.371、0.798。
结论 上下肢PI基础差值可作为预测子宫下段剖宫产手术腰硬联合麻醉发生低血压的有效指标。 |
| 英文摘要: |
Objective To assess the accuracy and feasibility of evaluating the incidence of hypotension in combined spinal-epidural anesthesia (CSEA) for cesarean section by perfusion index (PI) of the upper and lower limbs.
Methods A total of 166 patients with uterine caesarean section aged 20 - 35 years, BMI 20 - 40 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, fasting not less than 8 h were included. Non-invasive cuff blood pressure monitoring after entering the room and measured the PI value of the upper and lower limbs after the pregnant women were stabilized, and were given rapid intravenous infusion of hydroxyethyl starch 500 ml. CSE was done at the left lateral position, were blood pressure and PI value continuous monitored and recorded before anesthesia till 10 min after anesthesia, a reduction of arterial systolic blood pressure exceeding 20％ of the baseline value was considered as maternal hypotension. According to the monitoring results, they were divided into low blood pressure (n = 77) and no hypotension group (n = 89), and the receiver operating characteristic curve was generated by plotting the PI values of the upper and lower extremities and their diffe-rence to determine the incidence of hypotension. ROC). The diagnostic threshold, area under curve (AUC) and 95％ confidence interval (CI) were calculated.
Results The AUC of the ROC curve to estimate the incidence of hypotension was 0.661, 0.619, and 0.876. The diagnostic thresholds were 1.81, 0.873, and 1.094, respectively. The sensitivity to determine the incidence of hypotension was 0.481, 0.883, and 0.818, respectively. The specificities were 0.798, 0.371, and 0.798, respectively.
Conclusion The difference in the upper and lower extremity PI can be used as an effective indicator for predicting hypotension in combined spinal and epidural anesthesia in the lower uterine cesarean section. |
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