锁骨下静脉塌陷指数对剖宫产产妇腰麻后低血压的预测价值

Predictive effect of subclavian vein collapsible index on hypotension after spinal anesthesia in puerpera undergoing cesarean section

中文关键词: 锁骨下静脉  塌陷指数  剖宫产  低血压

英文关键词: Subclavian vein  Collapsible index  Cesarean section  Hypotension

中文摘要:

      
目的 探讨超声测量锁骨下静脉直径（dSCV）及锁骨下静脉塌陷指数（SCV-CI）对剖宫产产妇腰麻后低血压的预测价值。
方法 纳入择期剖宫产单胎产妇101例，年龄18~40岁，ASA Ⅰ或Ⅱ级，孕37~42周。于腰麻前后采用超声测量最大dSCV (dSCVmax)和SCV-CI。根据产妇腰麻后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）。采用Pearson相关分析dSCVmax、SCV-CI与腰麻后低血压之间的关系，并采用受试者工作特征(ROC)曲线评价dSCVmax、SCV-CI对腰麻后低血压的预测价值。
结果 腰麻后有44例（43.6%）产妇发生低血压。与N组比较，H组腰麻前后dSCVmax明显降低，SCV-CI明显升高（P<0.01）。腰麻前后dSCVmax预测腰麻后低血压的ROC曲线下面积（AUC）分别为0.806、0.903，临界值分别为8.0 cm、6.5 cm，敏感性分别为80.84%、75.00%，特异性分别为57.89%、94.74%（P<0.01）。腰麻前后SCV-CI预测腰麻后低血压的AUC分别为0.871、0.914，临界值分别为38.24%、37.68%，敏感性分别为70.45%、93.18%，特异性分别为96.49%、98.25%（P<0.01）。
结论 腰麻前和腰麻后SCV-CI在预测剖宫产产妇腰麻后低血压具有一定价值，且腰麻后SCV-CI更具有临床意义。

英文摘要:

      
Ojective To investigate the predictive effect of subclavian vein diameter (dSCV) and collapsible index of subclavian vein (SCV-CI) on hypotension after spinal anesthesia in puerpera undergoing cesarean section.
Methods A total of 101 singletons puerpera undergoing elective cesarean section with gestational age of 37-42 weeks, aged 18-40 years, falling into ASA physical status Ⅰ or Ⅱ, were enrolled in this study. The maximum dSCV (dSCVmax) and SCV-CI were measured by ultrasound before and after spinal anesthesia. All puerpera were divided into two groups according to the occurrence of hypotension after spinal anesthesia, named non-hypotension group (group N) and hypotension group (group Ｈ). Pearson correlation was used to analyze the relationship between dSCVmax, SCV-CI and hypotension after spinal anesthesia, and receiver operating characteristic (ROC) curve　was used to evaluate the predictive value of dSCVmax and SCV-CI for hypotension.
Results The incidence of hypotension after spinal anesthesia was 43.6%. Compared with group N, dSCVmax decreased and SCV-CI increased in group Ｈ (P < 0.01). The area under curve (AUC) of dSCVmax before and after spinal anesthesia for predicting hypotension after spinal anesthesia were 0.806 and 0.903, the critical values were 8.0 cm and 6.5 cm, the sensitivity were 80.84% and 75.00%, and the specificity were 57.89% and 94.74%, respectively (P < 0.01). The AUC predicted by SCV-CI before and after anesthesia were 0.871 and 0.914, respectively, the critical value was 38.24% and 37.68%, the sensitivity was 70.45% and 93.18%, and the specificity was 96.49% and 98.25%, respectively (P < 0.01).
Conclusion SCV-CI before and after lumbar anesthesia has certain value in predicting postpartum hypotension of cesarean section women, and SCV-CI after lumbar anesthesia is more clinically significant.