超声测量下腔静脉塌陷指数在评估危重症产妇麻醉前血容量中的应用

高娇娇; 李晓红; 陶静; 代文涛

doi:10.16766/j.cnki.issn.1674-4152.003065

超声测量下腔静脉塌陷指数在评估危重症产妇麻醉前血容量中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003065

蚌埠医学院第一附属医院麻醉科，安徽蚌埠 233004

基金项目:

安徽省教育厅卓越人才培养创新项目 2020zyrc104

详细信息

通讯作者:
李晓红，E-mail: lxh552@hotmail.com

中图分类号: R614.4
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出版历程
- 收稿日期: 2022-08-13
- 网络出版日期: 2023-08-28

Application of ultrasound measurement of inferior vena cava collapse index in evaluating pre-anesthesia blood volume in critically ill pregnant women

Department of Anesthesiology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨超声测量危重症产妇下腔静脉塌陷指数(IVC-CI)用于评估其麻醉前血容量的临床价值。方法选取蚌埠医学院第一附属医院2021年9月—2022年7月择期行剖宫产手术的危重症产妇90例，采用随机数字表法分为常规补液组(C组)、中心静脉压补液组(CVP组)、超声测量下腔静脉补液组(IVC组)，每组30例。记录并比较3组患者各时点收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、乳酸值(Lac)，手术时间、出血量、液体总入量、血管活性药使用率和腰麻后低血压发生率。记录IVC组补液前后中心静脉压(CVP)、最大下腔静脉直径(dIVCmax)和最小下腔静脉直径(dIVCmin)，计算IVC-CI并分析其与CVP的相关性。结果在麻醉后5 min(T1)、胎儿取出后(T2)、手术结束时(T3)，C组SBP、DBP、MAP值均低于CVP组和IVC组(P<0.05)；在T1时点，C组HR、乳酸值均高于CVP组和IVC组(F=11.650、7.860, P<0.05)。C组液体总入量[(740.00±156.01)mL]低于CVP组[(975.00±198.54)mL]和IVC组[(967.33±179.60)mL，F=16.711, P<0.001]。IVC组中dIVCmax、dIVCmin与CVP呈正相关关系(r=0.937、0.873, P<0.05)，IVC-CI与CVP呈负相关关系(r=-0.688, P<0.05)。结论下腔静脉塌陷指数可用于评估危重症产妇麻醉前血容量，并指导补液。
- 下腔静脉 /
- 塌陷指数 /
- 危重症产妇 /
- 容量 /
- 评估
Abstract: Objective To explore the clinical value of ultrasound measurement of inferior vena cava collapse index (IVC-CI) in critically ill pregnant women for evaluating their pre-anesthesia blood volume. Methods A total of 90 critically ill pregnant women who underwent elective cesarean section at the First Affiliated Hospital of Bengbu Medical College from September 2021 to July 2022 were selected and randomly divided into a routine fluid replacement group (C group), a central venous pressure fluid replacement group (CVP group), and an ultrasound measured inferior vena cava fluid replacement group (IVC group), with 30 cases in each group. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), lactate value (Lac), surgical time, bleeding volume, total fluid intake, vasoactive drug use rate, and incidence of postoperative hypotension among three groups of patients at different time points were record and compared. The central venous pressure (CVP), maximum inferior vena cava diameter (dIVCmax), and minimum inferior vena cava diameter (dIVCmin) before and after fluid replacement in the IVC group were record, the IVC-CI was calculated and analyzed its correlation with CVP. Results At 5 minutes after anesthesia (T1), after fetal removal (T2), and at the end of surgery (T3), the SBP, DBP, and MAP values in Group C were lower than those in the CVP and IVC groups (P<0.05). At time point T1, the HR and lactate values in Group C were higher than those in the CVP and IVC groups (F=11.650, 7.860, P<0.05). The total liquid intake in Group C [(740.00±156.01)mL] was lower than that in the CVP [(975.00±198.54)mL] and IVC groups [(967.33±179.60)mL, F=16.711, P<0.001]. In the IVC group, dIVCmax and dIVCmin were positively correlated with CVP (r=0.937, 0.873, P<0.05), while IVC-CI was negatively correlated with CVP (r=-0.688, P<0.05). Conclusion The inferior vena cava collapse index can be used to evaluate the pre-anesthesia blood volume of critically ill pregnant women and guide fluid replacement.
- Inferior vena cava /
- Collapse index /
- Critically ill pregnant women /
- Capacity /
- Assessment

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表 1 3组危重症产妇一般资料比较(x±s)

Table 1. Comparison of general data among three groups of critically ill parturients (x±s)

组别	例数	年龄(岁)	孕周(周)	BMI
C组	30	33.17±3.55	38.13±1.78	27.99±1.69
CVP组	30	32.13±3.67	38.15±0.99	28.74±1.71
IVC组	30	33.90±3.65	38.17±0.96	28.19±2.21
F值		1.797	0.003	1.261
P值		0.172	0.997	0.289

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表 2 3组危重症产妇各时点SBP比较(x±s，mmHg)

Table 2. Comparison of SBP at different time points in 3 groups of critically ill parturients (x±s, mmHg)

组别	例数	T0	T1	T2	T3	F值	P值
C组	30	151.67±19.80	107.87±8.01^a	114.03±7.33^a	116.23±8.59^ac	80.597	< 0.001
CVP组	30	147.23±18.91	118.97±10.12^ab	126.37±7.85^abc	124.50±9.17^ab	30.363	< 0.001
IVC组	30	144.17±18.78	117.53±10.52^ab	123.40±9.64^ab	122.30±9.09^ab	26.262	< 0.001
F值		1.161	11.836	17.904	6.863
P值		0.318	< 0.001	< 0.001	0.002
注：与同组T0时刻比较，^aP<0.05；与同时间点C组比较，^bP<0.05。1 mmHg=0.133 kPa。

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表 3 3组危重症产妇各时点DBP比较(x±s，mmHg)

Table 3. Comparison of DBP in 3 groups of critically ill parturients at different time points (x±s, mmHg)

组别	例数	T0	T1	T2	T3	F值	P值
C组	30	95.53±12.74	74.93±6.72^a	77.40±6.34^a	78.13±5.65^a	38.371	< 0.001
CVP组	30	93.43±11.15	81.53±6.75^ab	80.90±6.24^ab	82.23±5.27^ab	15.280	< 0.001
IVC组	30	98.13±11.24	83.63±8.37^ab	84.13±7.40^ab	84.73±6.44^ab	19.548	< 0.001
F值		1.208	10.986	7.622	9.921
P值		0.304	< 0.001	0.001	< 0.001
注：与同组T0时刻比较，^aP<0.05；与同时间点C组比较，^bP<0.05。

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表 4 3组危重症产妇各时点MAP比较(x±s，mmHg)

Table 4. Comparison of MAP at different time points in 3 groups of critically ill parturients (x±s, mmHg)

组别	例数	T0	T1	T2	T3	F值	P值
C组	30	107.80±16.10	76.03±8.02^a	81.23±8.04^a	86.87±5.86^acd	55.121	< 0.001
CVP组	30	108.23±12.20	91.67±9.58^ab	85.30±6.75^abc	90.60±5.80^abc	36.927	< 0.001
IVC组	30	111.83±14.67	90.37±9.11^b	88.57±8.05^b	90.63±5.58^b	22.974	< 0.001
F值		0.708	28.341	6.939	4.258
P值		0.495	< 0.001	0.002	0.017
注：与同组T0时刻比较，^aP<0.05；与同时间点C组比较，^bP<0.05。

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表 5 3组危重症产妇各时点HR比较(x±s，次/min)

Table 5. Comparison of HR at different time points in 3 groups of critically ill parturients (x±s, times /min)

组别	例数	T0	T1	T2	T3	F值	P值
C组	30	78.43±8.34	90.20±9.47^a	81.97±8.41	76.90±6.83	15.617	< 0.001
CVP组	30	80.37±6.77	84.67±5.32^ab	78.50±5.28	76.93±4.89^a	10.642	< 0.001
IVC组	30	78.10±7.55	81.17±6.50	77.70±7.52	76.13±6.76	2.644	0.520
F值		0.782	11.650	1.928	0.159
P值		0.461	< 0.001	0.152	0.854
注：与同组T0时刻比较，^aP<0.05；与同时间点C组比较，^bP<0.05。

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表 6 3组危重症产妇乳酸值比较(x±s，mmol/L)

Table 6. Comparison of lactate values in 3 groups of critically ill parturients (x±s, mmol/L)

组别	例数	T0	T1	T2	T3	F值	P值
C组	30	0.94±0.28	1.46±0.49^a	1.12±0.37	1.02±0.30	11.698	< 0.001
CVP组	30	0.98±0.19	1.10±0.40^b	1.05±0.29	1.05±0.30	0.641	0.590
IVC组	30	0.92±0.23	1.06±0.41^b	0.98±0.27	0.99±0.25	0.482	0.697
F值		0.534	7.860	1.590	0.366
P值		0.588	0.001	0.210	0.695
注：与同组T0时刻比较，^aP<0.05；与C组比较，^bP<0.05。

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表 7 3组危重症产妇手术时间、术中出血量、液体总入量情况比较(x±s)

Table 7. Comparison of operation time, intraoperative blood loss and total fluid intake among three groups of critically ill parturients (x±s)

组别	例数	手术时间(min)	术中出血量(mL)	液体总入量(mL)
C组	30	70.00±8.01	237.00±70.40	740.00±156.01
CVP组	30	71.20±9.39	254.00±78.55	975.00±198.54^a
IVC组	30	70.97±7.18	221.17±49.37	967.33±179.60^a
F值		0.179	1.789	16.711
P值		0.837	0.173	< 0.001
注：与C组比较，^aP<0.05。

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表 8 3组危重症产妇血管活性药物使用率、低血压发生率比较[例(%)]

Table 8. Comparison of utilization rate of vasoactive drugs and incidence rate of hypotension in 3 groups of critical ill parturients[cases (%)]

组别	例数	血管活性药物	发生低血压
C组	30	15(50.0)	18(60.0)
CVP组	30	4(13.3)^a	6(20.0)^a
IVC组	30	2(6.7)^a	3(10.0)^a
χ²值		18.261	20.000
P值		< 0.001	< 0.001
注：与C组比较，^aP<0.017。

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表 9 IVC组危重症产妇补液前后相关指标比较(x±s)

Table 9. Comparison of relevant indexes before and after fluid rehydration in critically ill parturients in IVC group (x±s)

时间	CVP(mmHg)	IVCmax(cm)	IVCmin(cm)	IVC-CI(%)
补液前	4.47±1.30	1.51±0.31	0.93±0.13	40.43±6.10
补液后	8.10±1.49	2.14±0.10	1.64±0.18	23.78±7.34
t值	-8.537	-12.216	-18.195	9.337
P值	< 0.001	< 0.001	< 0.001	< 0.001

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表 10 IVC组危重症产妇中IVC-CI相关指标与CVP相关性比较

Table 10. Correlation between IVC-CI related indicators and CVP in critically ill parturiants in IVC group

项目	CVP
项目	r值	P值
dIVCmax	0.937	0.001
dIVCmin	0.873	0.001
IVC-CI	-0.688	0.048

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