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| 颈内静脉内径呼吸变异度和血流速度在椎管内麻醉后容量预测中的价值 |
| Ultrasonic measurement of respiratory variability and blood flow velocity of internal jugular vein and the value of intraspinal anesthesia |
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| DOI：10.12089/jca.2020.05.007 |
| 中文关键词: 超声引导 椎管内麻醉 颈内静脉内径 呼吸变异度 血流速度 血容量 |
| 英文关键词: Ultrasound testing Intraspinal anesthesia Internal jugular vein diameter Respiratory variability Blood flow velocity Blood volume |
| 基金项目: |
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| 摘要点击次数: 2002 |
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| 中文摘要: |
目的 探究超声测量颈内静脉内径呼吸变异度和血流速度在椎管内麻醉后血容量判断中的价值。
方法 选择我院2017年2月至2019年2月择期手术的椎管内麻醉患者120例，男64例，女56例，年龄为34~66岁，ASAⅠ或Ⅱ级。记录麻醉前、麻醉后5、15、25 min左侧颈内静脉最大直径（Dmax）、最小直径（Dmin）、内径呼吸变异度（RVI）、中心静脉压（CVP）、血流速度最大值（BVmax）、血流速度最小值（BVmin）和血流速度变异度（BVI），取CVP=6 mmHg作为预测值，并通过绘制ROC曲线来评估Dmax、Dmin、RVI、BVmax、BVmin和BVI的预测效能。
结果 与麻醉前比较，麻醉后5 min时Dmax、Dmin和BVI明显降低（P<0.05），RVI明显升高（P<0.05）；与麻醉后5和15 min比较,麻醉后25 min，Dmax、Dmin和BVI明显升高（P<0.05），RVI明显降低（P<0.05）。麻醉前BVmin的AUC值最大为0.958，临界值6.86，敏感性82.6%，特异性95.2%；麻醉后5 min，Dmin的AUC值最大为0.944，临界值0.74，敏感性98.4%，特异性84.3%；麻醉后15 min，Dmin和BVmax的AUC值最大分别为0.949和0.945，临界值分别为0.72和7.99，敏感性分别为96.5%和89.8%，特异性分别为82.4%和82.1%；麻醉后25 min，BVmax的AUC值最大为0.981，临界值8.98，敏感性92.0%，特异性90.5%。
结论 超声测量患者颈内静脉的内径变异度和血流速度可作为预测椎管内麻醉后血容量的方式。 |
| 英文摘要: |
Objective To investigate the value of ultrasound in measuring the respiratory variability and blood flow velocity of the internal jugular vein and the blood volume after spinal anesthesia.
Methods Retrospective analysis of 120 patients, 64 males and 56 females, aged 34-66 years, falling into ASA physical status Ⅰ or Ⅱ, who underwent surgical treatment and spinal anesthesia during February 2017-2019 in our hospital was enrolled in our study and underwent spinal anesthesia. Before anesthesia, 5 min, 15 min and 25 min after anesthesia, ROC curves were drawn in the correlation with Dmax, Dmin, RVI, BVmax, BVmin, BVI and CVP(6 mmHg).
Results Compared with that before anesthesia, Dmax, Dmin and BVI decreased significantly at 5 min after anesthesia (P < 0.05), while RVI increased significantly (P < 0.05). Compared with 5 and 15 min after anesthesia, at after 25 min of anesthesia, Dmax, Dmin and BVI significantly increased (P < 0.05), while RVI significantly decreased (P < 0.05). The maximum AUC value of BVmin before anesthesia was 0.958, the critical value was 6.86, the sensitivity was 82.6%, and the specificity was 95.2%. Five minutes after anesthesia, the maximum AUC value of Dmin was 0.944, the critical value was 0.74, the sensitivity was 98.4%, and the specificity was 84.3%. At 15 minutes after anesthesia, the maximum AUC values of Dmin and BVmax were 0.949 and 0.945, the critical values were 0.72 and 7.99, the sensitivity was 96.5% and 89.8%, and the specificity was 82.4% and 82.1%, respectively. The AUC value of BVmax was the highest (0.981) 25 minutes after anesthesia, with a critical value of 8.98, sensitivity of 92.0% and specificity of 90.5%.
Conclusion The use of ultrasound to detect the internal diameter variability and blood flow velocity of the patient's internal jugular vein can be used as a way to clinically detect blood volume after spinal anesthesia, thus providing guidance for the infusion volume after clinical spinal anesthesia. |
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