国际麻醉学与复苏杂志   2023, Issue (6): 0-0
    
超声测量颈总动脉校正血流时间预测麻醉诱导后低血压
杨勇勇, 杨菲, 吴黄辉, 李敏, 陈国忠1()
1.福建医科大学附属第一医院
Ultrasonic measurement of corrected flow time in the common carotid artery predicts hypotension after anesthesia induction
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摘要：

目的 探究麻醉诱导前使用超声测量颈总动脉校正血流时间（corrected flow time, FTc）预测麻醉诱导后患者低血压的价值。 方法 选取择期全麻手术患者110例。麻醉诱导前超声测量患者颈总动脉FTc，麻醉诱导后记录患者血流动力学指标并观察是否出现低血压及血压降低程度，根据诱导后是否出现低血压将患者分为低血压组（44例）和非低血压组（56例），绘制受试者工作特征（receiver operating characteristic curve, ROC）曲线，计算曲线下面积（area under the cure, AUC），统计分析FTc预测麻醉诱导后低血压的敏感度和特异度，并求出预测的最佳阈值，计算约登指数。运用灰色区域法确定颈总动脉测量值的范围，采用Pearson相关检验诱导前颈总动脉FTc与麻醉诱导后MAP较基础值下降百分比之间的相关性。对麻醉诱导后低血压的影响因素进行多因素logistic回归分析。 结果 麻醉诱导后低血压组和非低血压组的FTc分别为（320±15） ms和（345±20） ms。FTc的AUC为0.833（95%CI 0.766~0.920，P<0.05），最佳阈值为335.83 ms（敏感度88.64%，特异度76.79%），约登指数为0.654。颈总动脉FTc的灰色区域范围在315~337 ms，范围内包含了20个患者。麻醉诱导前测量颈总动脉FTc和麻醉诱导后MAP较基础值下降百分比二者间存在中度负相关关系（r=−0.593，P<0.001）。颈总动脉FTc和基础SBP是预测麻醉诱导后低血压的独立预测因子，其调整优势比分别为0.902（95%CI 0.864~0.942，P<0.001)、1.142（95%CI 1.059~1.230，P<0.001）。 结论 麻醉诱导前超声测量颈总动脉FTc对于麻醉诱导后出现低血压具有良好的预测价值。
关键词： 超声监测； 颈总动脉； 校正血流时间； 低血压
Abstract:

Objective To explore ultrasonic measurement of corrected flow time (FTc) in the common carotid artery before anesthesia induction for predicting hypotension after anesthesia induction. Methods A total of 110 patients who were scheduled for elective surgery under general anesthesia were enrolled. Before anesthesia induction, their FTc in the common carotid artery was measured by ultrasonography. After anesthesia induction, their hemodynamic indicators were recorded and the presence of hypotension and the degree of reduction were observed. According to the presence of hypotension after induction, the patients were divided into two groups: a hypotensive group (n=44) and a non‑hypotensive group (n=56). A receiver operating characteristic (ROC) curve was plotted to calculate the area under the curve (AUC), while the sensitivity and specificity of FTc to predict post‑induction hypotension was analyzed. The optimal cut‑off value was predicted, and the Yordon index was calculated. The grey area method was used to determine the measurement of the common carotid artery. The Pearson correlation was used to determine the correlation between FTc in the common carotid artery before anesthesia and the percentage of mean arterial pressure (MAP) decrease from baseline value after anesthesia induction. Multifactor logistic regression analysis was conducted to analyze the influencing factors of hypotension after anesthesia induction. Results After anesthesia induction, the FTc value was (320±15) ms for the hypotensive group, and (345±20) ms for the non‑hypotensive group. The AUC of FTc was 0.833 [[95% confidence interval (CI) 0.766, 0.920], P<0.05], while the optimal cutoff value was 335.83 ms, with a sensitivity of 88.64% and a specificity of 76.79%, and the Yordan index was 0.654. The grey zone for FTc in the common carotid artery ranged from 315 ms to 337 ms, including 20 patients. There was a moderate negative correlation between FTc in the common carotid artery before anesthesia and the percentage of MAP decrease from baseline value after anesthesia induction (r=−0.593, P<0.001). FTc in the common carotid artery and basal SBP were independent predictors of hypotension after anesthesia induction, and their adjusted odds ratios were 0.902 [95%CI (0.864,0.942), P<0.001] and 1.142 [95%CI (1.059,1.230), P<0.001], respectively. Conclusion Ultrasonic measurement of FTc in the common carotid artery before anesthesia induction can well predict hypotension after anesthesia induction.
Key words: Ultrasonic monitoring; Common carotid artery; Corrected flow time; Hypotension