Value of analyzing the parameters of vena cava blood volume status in early prediction of hypotension after spinal anesthesia in orthopaedic surgery
Objective To explore the early predictive value of inferior vena cava collapse index(IVC-CI)and pulse perfu-sion variability index(PVI)as two parameters of vena cava blood volume status for postoperative hypotension in orthope-dic surgery patients under spinal anesthesia.Methods Totally 106 orthopedic surgery patients admitted to Tianjin First Central Hospital from October 1,2020 to October 1,2021 were selected as the research subjects.All patients were given the same anesthesia method,and related indicators such as heart rate(HR),diastolic blood pressure(DBP),mean arteri-al pressure(MAP),systolic blood pressure(SBP),IVC-CI,and PVI were measured before surgery.The incidence of postoperative hypotension in two groups of patients after spinal anesthesia was compared,logistic regression analysis to was used to identify the influencing factors of postoperative hypotension,and the predictive value of IVC-CI for spinal an-esthesia hypotension was evaluated using receiver operating characteristic(ROC)curves.Results Among 106 orthopedic surgery patients,31 cases(29.25％)experienced hypotension,while 75 cases(70.75％)had normal blood pressure.The results of univariate analysis showed that preoperative vasoconstrictive drugs(x2=8.857,P=0.003),inferior vena cava ultrasound-guided infusion(x2=7.705,P=0.006),and hypertension as the underlying disease(x2=8.514,P=0.004)were related to the occurrence of hypotension.The IVC-CI of the hypotension group was(39.48±4.21)％,which was higher than that of the normal blood pressure group(33.42±3.88)％,t=7.135,P＜0.001.The PVI of the hypotension group(19.61±3.94)％was higher than that of the normal blood pressure group(14.82±3.50)％,t=6.176,P＜0.001.The results of binary logistic regression analysis showed that hypertension(OR=2.875,95％CI was 1.154-7.163,P=0.023),IVC-CI(OR=1.511,95％CI was 1.257-1.816,P＜0.001),and elevated PVI values(OR=1.432,95％CI was 1.222-1.677,P＜0.001)were risk factors for hypotension in patients with lumbar anesthesia.Infe-rior vena cava ultrasound guided infusion(OR=0.288,95％CI was 0.117-0.710,P=0.007),and the use of vasocon-strictive drugs(OR=0.285,95％CI was 0.102-0.796,P=0.017)were protective factors for hypotension after spinal anesthesia.The ROC curve results showed that the area under curve predicted by IVC-CI and PVI for hypotension in patients with lumbar anesthesia were 0.867 and 0.809,respectively,and the combined predicted was 0.941.Conclusions Hyperten-sion,elevated IVC-CI and PVI values are risk factors for hypotension in patients undergoing spinal anesthesia.The use of vasoconstrictive drugs and guidance of intravenous infusion with inferior vena cava ultrasound are protective factors for hypotension after spinal anesthesia.Moreover,IVC-C and PVI have good predictive value for the occurrence of hypoten-sion after spinal anesthesia.
NETL
NSTL
万方数据
