诊断学理论与实践

诊断学理论与实践 ›› 2020, Vol. 19 ›› Issue (02): 135-138.doi: 10.16150/j.1671-2870.2020.02.007

• 论著 • 上一篇    下一篇

超声测量下腔静脉塌陷指数预测产妇脊椎麻醉后仰卧位低血压综合征发生的价值

姚世发1a,2, 牛建梅1a,2(), 徐韬1b   

  1. 1.上海交通大学医学院附属国际和平妇幼保健院a. 超声科,b. 麻醉科,上海 200030
    2.上海市胚胎源性疾病重点实验室,上海市临床重点专科（建设项目）-“强主体”妇产科,上海 200030
  • 收稿日期:2020-01-09 出版日期:2020-04-25 发布日期:2020-04-25
  • 通讯作者: 牛建梅 E-mail:niujm5@126.com

The performance of the inferior vena cava collapse index(IVC-CI) measured by ultrasound on predicting supine hypotension syndrome(SHS) in parturients following spinal anesthesia

YAO Shifa1a,2, NIU Jianmei1a,2(), XU Tao1b   

  1. 1a. Department of Ultrasound, 1b. Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
    2. Shanghai Key Laboratory of Embryo Origi-nal Diseases, Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China
  • Received:2020-01-09 Online:2020-04-25 Published:2020-04-25
  • Contact: NIU Jianmei E-mail:niujm5@126.com

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摘要：

目的：产前应用超声测量不同体位时产妇的下腔静脉塌陷指数(inferior vena cava collapse index,IVC-CI),探究其在预测脊椎麻醉后仰卧位低血压综合征（supine hypotension syndrome,SHS）中的应用价值。方法：剖宫产手术前,分别在产妇左侧卧位及平卧位时,采用超声测量下腔静脉呼气末最大直径（inferior vena cava maximal diameter during quiet expiration,IVCe）、下腔静脉吸气末最小直径（inferior vena cava minimal diameter during quiet inspiration,IVCi）,并计算不同体位时IVC-CI及平卧位与左侧卧位的IVC-CI差值（ΔIVC-CI）。依据脊椎麻醉后SHS的发生情况,将102例行剖宫产的单胎产妇分为SHS组和非SHS组,比较2组间各超声测量参数的差异。结果：在102例产妇中,54例在脊椎麻醉后发生SHS。SHS组和非SHS组产妇在平卧位时的IVCe、IVCi均比自身左侧卧位时明显降低（P<0.01）,2组产妇在平卧位时的IVC-CI均比自身左侧卧位时明显增高（P<0.01）。SHS组与非SHS组比较,左侧卧位时的IVCe、IVCi、IVC-CI差异无统计学意义（P<0.01）,而SHS组平卧位时的IVCe、IVCi较非SHS组均明显降低（P<0.01）,SHS组平卧位时的IVC-CI较非SHS组均明显增高（P<0.01）;SHS组ΔIVC-CI较非SHS组明显增高（P<0.01）。平卧位时的IVC-CI、ΔIVC-CI预测产妇脊椎麻醉后SHS发生的受试者操作特征曲线（receiver operator characteristic curve,ROC曲线）下面积分别为0.941、0.927,当平卧位IVC-CI取41.43%、ΔIVC-CI取14.09%作为预测产妇脊椎麻醉后发生SHS的临界值时,其预测灵敏度分别为88.9%、87.0%,特异度分别为98.8%、87.5%。结论：产前采用超声测量产妇平卧位时的IVC-CI及ΔIVC-CI,在一定程度上可预测其脊椎麻醉后SHS的发生风险。

关键词: 产妇, 脊椎麻醉, 仰卧位低血压综合征, 下腔静脉塌陷指数

Abstract:

Objective: To evaluate the performance of the inferior vena cava collapse index(IVC-CI) measured by ultrasound on predicting supine hypotension syndrome (SHS) in parturients following spinal anesthesia. Methods: A total of 102 single-fetus parturients scheduled for cesarean section were prospectively enrolled in the study. The inferior vena cava maximal diameter during quiet expiration (IVCe) and expiration(IVCi) in both supine and left lateral position were measured by ultrasound to calculate IVC-CI and IVC-CI in different position(ΔIVC-CI) sprior to spinal anesthesia. The ΔIVC-CI was deduced to represent the impact of postural change. The parameters including IVCe, IVCi, IVC-CI and ΔIVC-CI were compared between parturients with and without SHS. Result: Fifty-four parturients presented SHS after spinal anesthesia. The parturients were predisposed to lower IVCe and IVCi, and higher IVC-CI in supine position than left lateral position(P<0.01). There was no difference in IVCe, IVCi and IVC-C of parturients between with and without SHS in left lateral position(P>0.05). The IVCe and IVCi measured in supine position were lower, and IVC-CI in supine position and ΔIVC-CI were higher in parturients with SHS (P<0.01). The areas under ROC curve (AUC) of IVC-CI and ΔIVC-CI for prediction of SHS were 0.941 and 0.927. With the cutoff value of 41.43% and 14.09%, the sensitivity and specificity of IVC-CI and ΔIVC-CI for predicting SHS in supine position were 88.9% and 98.8%, and 87.0% and 87.5%, respectively. Conclusion: The IVC-CI measured in supine position and ΔIVC-CI by ultrasound prior to spinal anesthesia could be used to assess the risk of incidence of SHS.

Key words: Parturients, Spinal anesthesia, Supine hypotension syndrome, Inferior vena cava collapse index

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