心率和脉搏灌注变异指数对剖宫产脊麻后低血压的预测作用
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摘要
目的探讨HR和脉搏灌注变异指数(PVI)对剖宫产脊麻后低血压的预测作用。方法选择择期脊麻下剖宫产的产妇80例,年龄18~40岁,BMI 20~40kg/m2,ASAⅠ或Ⅱ级。在L3-4间隙行硬腰联合麻醉。记录麻醉前后的HR、PVI、BP和MAP。探讨HR和PVI与脊麻后低血压的相关性。结果与未发生低血压的产妇比较,发生低血压的产妇HR基础值明显增快、PVI基础值明显增大(P <0.05)。HR基础值预测低血压的ROC曲线下面积为0.77(P <0.05),最佳阈值为≥84次/分,预测低血压的敏感度和特异度分别为70.7%和81.8%,阳性预测值和阴性预测值分别为91.1%和51.4%。PVI基础值预测低血压的ROC曲线下面积为0.74(P <0.05),最佳阈值为≥21%,预测低血压的敏感度和特异度分别为44.8%和95.5%,阳性预测值和阴性预测值分别为96.3%和39.2%。HR基础值联合PVI基础值预测低血压的ROC曲线下面积为0.86(P <0.05),最佳阈值为≥86次/分(HR)或≥21%(PVI),预测低血压的敏感度和特异度分别为82.8%和86.4%,阳性预测值和阴性预测值分别为92.5%和66.7%。结论脊麻前较大的心率基础值和脉搏灌注变异指数基础值与剖宫产脊麻后低血压相关,联合使用这两个指标可以用于临床预测剖宫产脊麻后低血压。
Objective To investigate the role of heart rate(HR)and pleth variability index(PVI)for prediction of hypotension after spinal anaesthesia for cesarean section.Methods Eightyfive parturients undergoing elective cesarean section under spinal anaesthesia were selected.HR,PVI,blood pressure before and after anaesthesia were recorded.The association of baseline HR and PVI with hypotension after spinal anaesthesia was explored.Results Hypotension occurred in 58 parturients.Baseline HR and baseline PVI before anaesthesia in parturients with hypotension were higher than those in parturients without hypotension (P < 0.05).The values of area under the receiver operation characteristic curve were 0.77,0.74 and 0.86 for baseline HR,baseline PVI,and baseline HR combined with baseline PVI,respectively,for prediction of hypotension (P < 0.05).Conclusion Greater baseline HR and baseline PVI before spinal anaesthesia are associated with hypotension after spinal anaesthesia for cesarean section,and the combination of these two parameters can be a clinically useful predictor.
Objective To investigate the role of heart rate(HR)and pleth variability index(PVI)for prediction of hypotension after spinal anaesthesia for cesarean section.Methods Eightyfive parturients undergoing elective cesarean section under spinal anaesthesia were selected.HR,PVI,blood pressure before and after anaesthesia were recorded.The association of baseline HR and PVI with hypotension after spinal anaesthesia was explored.Results Hypotension occurred in 58 parturients.Baseline HR and baseline PVI before anaesthesia in parturients with hypotension were higher than those in parturients without hypotension (P < 0.05).The values of area under the receiver operation characteristic curve were 0.77,0.74 and 0.86 for baseline HR,baseline PVI,and baseline HR combined with baseline PVI,respectively,for prediction of hypotension (P < 0.05).Conclusion Greater baseline HR and baseline PVI before spinal anaesthesia are associated with hypotension after spinal anaesthesia for cesarean section,and the combination of these two parameters can be a clinically useful predictor.
引文
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[9]徐子锋,张建海,郑吉建.脉搏灌注变异指数监测血容量变化的有效性.临床麻醉学杂志,2013,29(12):1187-1189.
[10]Keller G,Cassar E,Desebbe O,et al.Ability of pleth variability index to detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers.Crit Care,2008,12(2):R37.
[11]周平,常莉,王建东,等.被动抬腿试验联合脉搏灌注指数变异预测容量反应性的研究.中华急诊医学杂志,2014,23(12):1371-1375.
[12]蔡勤芳,米卫东,袁维秀.脉搏灌注指数变异监测机体容量状况的临床研究.中华外科杂志,2010,48(21):1628-1632.
[13]Fu Q,Mi WD,Zhang H.Stroke volume variation and pleth variability index to predict fluid responsiveness during resection of primary retroperitoneal tumors in Hans Chinese.Biosci Trends,2012,6(1):38-43.
[14]Siswojo AS,Wong DM,Phan TD,et al.Pleth variability index predicts fluid responsiveness in mechanically ventilated adults during general anesthesia for noncardiac surgery.J Cardiothorac Vasc Anesth,2014,28(6):1505-1509.
[15]Ueyama H,He YL,Tanigami H,et al.Effects of crystalloid and colloid preload on blood volume in parturient undergoing spinal anesthesia for elective cesarean section.Anesthesiology,1999,91(6):1571-1576.
[2]Dyer RA,Reed AR,van Dyk D,et al.Hemodynamic effects of ephedrine,phenylephrine and phenylephrine co-administered with oxytocin,during spinal anesthesia for elective cesarean delivery.Anesthesiology,2009,111(4):753-765.
[3]Langesaeter E,Rosseland LA,Stubhaug A.Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery:a randomized,double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion.Anesthesiology,2008,109(5):856-863.
[4]Wyffels PA,Durnez PJ,Helderweirt J,et al.Ventilation-induced plethysmographic variations predict fluid responsiveness in ventilated postoperative cardiac surgery patients.Anesth Analg,2007,105(2):448-452.
[5]Solus-Biguenet H,Fleyfel M,Tavernier B,et al.Non-invasive predictin of fluid responsiveness during major hepatic surgery.Br J Anaesth,2006,97(6):808-816.
[6]Natalini G,Rosano A,Taranto M,et al.Arterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients:a clinical trial.Anesth Analg,2006,103(6):1478-1484.
[7]Sun S,Huang SQ.Role of pleth variability index for predicting hypotension after spinal anesthesia for cesarean section.Int J Obstet Anesth,2014,23(4):324-329.
[8]Fr9lich MA,Caton D.Baseline heart rate may predict hypotension after spinal anesthesia in prehydrated obstetric patients.Can J Anaesth,2002,49(2):185-189.
[9]徐子锋,张建海,郑吉建.脉搏灌注变异指数监测血容量变化的有效性.临床麻醉学杂志,2013,29(12):1187-1189.
[10]Keller G,Cassar E,Desebbe O,et al.Ability of pleth variability index to detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers.Crit Care,2008,12(2):R37.
[11]周平,常莉,王建东,等.被动抬腿试验联合脉搏灌注指数变异预测容量反应性的研究.中华急诊医学杂志,2014,23(12):1371-1375.
[12]蔡勤芳,米卫东,袁维秀.脉搏灌注指数变异监测机体容量状况的临床研究.中华外科杂志,2010,48(21):1628-1632.
[13]Fu Q,Mi WD,Zhang H.Stroke volume variation and pleth variability index to predict fluid responsiveness during resection of primary retroperitoneal tumors in Hans Chinese.Biosci Trends,2012,6(1):38-43.
[14]Siswojo AS,Wong DM,Phan TD,et al.Pleth variability index predicts fluid responsiveness in mechanically ventilated adults during general anesthesia for noncardiac surgery.J Cardiothorac Vasc Anesth,2014,28(6):1505-1509.
[15]Ueyama H,He YL,Tanigami H,et al.Effects of crystalloid and colloid preload on blood volume in parturient undergoing spinal anesthesia for elective cesarean section.Anesthesiology,1999,91(6):1571-1576.