被动抬腿后每搏输出量变化率对全身麻醉诱导后低血压发生的预测价值

摘要

目的：探讨被动抬腿（PLR）后每搏输出量变化率（ΔSV）对全身麻醉（全麻）诱导后低血压发生的预测价值。方法44例全麻下行胃肠道手术的患者根据有无高血压病史分为高血压组（H组，24例）和血压正常组（N组，20例），分别监测两组患者麻醉诱导前后 HR、SBP、DBP和MAP的变化，计算PLR后ΔSV和麻醉诱导后低血压[SBP变化率（ΔSBP）≥20％]的发生率。结果 H组麻醉诱导后低血压发生率高于N组（79.1％ vs ．40.0％）（P＜0．05）。 H组PLR后ΔSV与ΔSBP呈正相关（r＝0．43，P＜0．05），N组PLR后ΔSV与ΔSBP无明显相关性（r＝0．34，P＞0．05）。H组和N组PLR后ΔSV的AUC分别为0.80和0.77。PLR后ΔSV预测H组和N组患者发生诱导后低血压的灵敏度分别为68.4％和87.5％，特异度分别为100％和75.0％，诊断界值分别为9.6％和7.7％。结论 PLR后ΔSV能预测全麻诱导后低血压的发生；与血压正常患者相比，ΔSV预测高血压患者发生全麻诱导后低血压的准确性与特异度高，而灵敏度低。%Objective To investigate the value of change rate of stroke volume (ΔSV ) after passive leg rising (PLR ) in predicting the occurrence of general anesthesia-induced hypotension . Methods Forty-four patients underwent gastrointestinal tract surgery under general anesthesia were divided into 2 groups of H (with a history of hypertension ,24 cases) and N (without a history of hypertension ,20 cases) .The changes of HR ,SBP ,DBP and MAP were monitored before and after anesthesia induction ,and ΔSV after PLR and the incidence of hypotension after anesthesia induction were calculated in 2 groups .The incidence rate of hypotension after anesthesia induction was defined as a change rate of SBP (ΔSBP)≥20% .Results The incidence rate of hypotension after anesthesia induction in group H was higher than that in group N (79.1% vs .40.0% )(P<0 .05) .The ΔSV after PLR was positively correlated with ΔSBP in group H(r=0 .43 ,P<0 .05) ,which was not in group N (r=0 .34 ,P>0 .05) .The AUC of ΔSV was 0.80 in group H and 0.77 in group N ,respectively .The sensitivities of ΔSV after PLR in predicting the occurrence of general anesthesia-induced hypotension in groups of H and N were 68.4% and 87.5% ,the specificities were 100% and 75.0% ,and the diagnostic thresholds were 9.6% and 7.7% ,respectively .Conclusion The ΔSV after PLR can accurately predict the occurrence of general anesthesia-induced hypotension .Compared with the patients without a history of hypertension ,ΔSV after PLR has higher accuracy and specificity and lower sensitivity in predicting occurrence of general anesthesia-induced hypotension in the patients with a history of hypertension .