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| 全膝关节置换术中蛛网膜下腔阻滞前每搏量变异度预测阻滞后低血压的效能 |
| Predictive effect of stroke volume variation before spinal anesthesia on hypotension after spinal anesthesia in elderly patients undergoing total knee arthroplasty |
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| DOI：10.12089/jca.2021.12.001 |
| 中文关键词: 蛛网膜下腔阻滞 每搏量指数 每搏量变异度 全膝关节置换术 低血压 |
| 英文关键词: Spinal anesthesia Stroke volume index Stroke volume variation Total knee arthroplasty Hypotension |
| 基金项目:江苏省重点实验室开放课题（XZSYSKF2019025） |
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| 中文摘要: |
目的 观察全膝关节置换术中蛛网膜下腔阻滞前每搏量指数（SVI）与每搏量变异度（SVV）对阻滞后低血压的预测价值。
方法 选择择期蛛网膜下腔阻滞下行全膝关节置换术的老年患者60例，男28例，女32例，年龄65～80岁，BMI 19.0～28.0 kg/m2，ASA Ⅱ或Ⅲ级。根据蛛网膜下腔阻滞后5 min是否发生低血压分为两组：未发生低血压组（N组）和发生低血压组（H组）。使用胸壁心脏超声测量蛛网膜下腔阻滞前10 min至蛛网膜下腔阻滞后5 min时吸气末与呼气末的每搏量（SV），计算SVI和SVV。绘制受试者工作特征曲线（ROC），计算曲线下面积（AUC），评价SVI、SVV对蛛网膜下腔阻滞后低血压的预测价值。
结果 蛛网膜下腔阻滞后5 min有22例（36.7%）患者发生低血压。与N组比较，蛛网膜下腔阻滞前10 min至蛛网膜下腔阻滞后5 min H组SVI明显降低，SVV明显升高（P<0.05）。蛛网膜下腔阻滞前10 min SVI、SVV预测蛛网膜下腔阻滞后低血压的AUC分别为0.869、0.922，临界值分别为31.2 ml/m2、15.42%，敏感性分别为89%、95%，特异性分别为75%、89%（P<0.05）。
结论 蛛网膜下腔阻滞前经超声测量SVI、SVV可以预测蛛网膜下腔阻滞后低血压，SVV诊断价值高于SVI。 |
| 英文摘要: |
Objective To observe the predictive effect of stroke volume index (SVI) and stroke volume variation (SVV) before spinal anesthesia on postspinal anaesthesia hypotension in elder patients undergoing total knee arthroplasty (TKA).
Methods Sixty patients underwent elective TKA under subarachnoid block, 28 males and 32 females, aged 65-80 years, BMI 19.0-28.0 kg/m2, ASA physical status Ⅱ or Ⅲ, were divided into non-hypotension group (group N) and hypotension group (group H) according to the occurrence of hypotension 5 minutes after spinal anesthesia. The stroke volume (SV) were measured by transthoracic echocardiography (TTE) at 10 minutes before spinal anesthesia to 5 minutes after spinal anesthesia, and SVI and SVV were calculated. Receiver operating characteristic (ROC) curves of SVI and SVV were adopted to predict hypotension, the area under the curve (AUC) were calculated.
Results The incidence of hypotension 5 minutes after spinal anesthesia was 36.7%. The SVI of group H was significantly lower than that in group N at 10 minutes before spinal anesthesia to 5 minutes after spinal anesthesia (P < 0.05). The SVV of group H was significantly higher than that in group N at 10 minutes before spinal anesthesia to 5 minutes after spinal anesthesia (P < 0.05). The AUC of SVI and SVV before spinal anesthesia was 0.869 and 0.922, the critical value was 31.2 ml/m2 and 15.42%, the sensitivity was 89% and 95%, and the specificity was 75% and 89%, respectively (P < 0.05).
Conclusion SVI and SVV before spinal anesthesia could predict postspinal anaesthesia hypotension. SVV is better in terms of sensitivity and specificity than SVI. |
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