Application Of Lung Ultrasound B-line In Perioperative Volume Therapy For Elderly Patients With Coronary Heart Disease

Objective Study the relationship between volume therapy and lung ultrasound B line score in elderly patients with coronary heart disease（CHD）at different time points during perioperative period,investigate the clinical value of lung ultrasound B line in the perioperative assessment of circulating volume in elderly patients with CHD,and analyze the related factors influencing the B line score,to provide a new strategy for elderly patients with CHD perioperative capacity evaluation.Methods Eighty elderly patients with CHD who performed non-cardiac surgery in the People’s Hospital of Ningxia Hui Autonomous Region from December 2019 to December2020 were selected.General data of patients were collected,including age,gender,BMI,NYHA grade,EF,ASA grade,duration of anesthesia,complications,smoking history and anesthesia method.Lung ultrasound B line score,mean arterial pressure and heart rate were recorded at 1 day before（T0）,before（T1）,after（T2）,and 1 day after（T3）.NT-proBNP,PaO₂/FiO₂,Hb were recorded at T1 and T2 time points.And record the intraoperative fluid volume,fluid speed,balance amount,crystal amount,colloid amount.Correlation analysis was conducted between B line score at each time point and indexes such as NT-proBNP,PaO₂/FiO₂,intraoperative fluid volume,fluid speed,crystal volume,colloid volume,etc.and binary Logistic regression was used to analyze the related influencing factors for the increase of B line score.Results（1）There was no statistically significant difference between T1 and T2NT-proBNP（p>0.05）.The PaO₂/FiO₂of T2 was decreased compared with T1,and Hb of T2was decreased compared with T1,the difference was statistically significant（p<0.05）.（2）T1MBP was higher than T0,T2 and T3 MBP were lower than T0.MBP in T2 and T3 was lower than that in T1,and the difference was statistically significant（p<0.05）.There was no statistically significant difference at other time points（p>0.05）.HR at T2 was lower than at other time points,and the difference was statistically significant（p<0.05）.There was no statistically significant difference at other time points（p>0.05）.B line score of T1 was lower than that of T0,and B line score of T2 was higher than that of T0.The score of B line in T2and T3 was higher than that in T1.The score of B line in T3 was lower than that in T2,and the difference was statistically significant（p<0.05）.There was no statistically significant difference at other time points（p>0.05）.（3）Spearman correlation analysis showed that B line score at T0 and T1 were not correlated with intraoperative fluid volume,fluid speed,balance amount,crystal amount and colloidal amount（p>0.05）,while B line score at T2 were positively correlated with intraoperative fluid volume,fluid speed,balance amount,crystal amount and colloidal amount（p<0.05）.The B line score at T3 time point had no correlation with the intraoperative fluid speed（p>0.05）,but was positively correlated with the intraoperative fluid volume,balance amount,crystal amount and colloid amount（p<0.05）.（4）There was no correlation between the score of B line and the preoperative EF,preoperative Hb and postoperative Hb（p>0.05）.（5）Logistic regression analysis showed that age,time of anesthesia and intraoperative fluid speed were independent risk factors for the increase of B line,with OR values of 1.175,1.039 and 1.013,respectively.Conclusion 1.Lung ultrasound B line score has a positive correlation with fluid volume and fluid speed,which can be used as a method to guide perioperative volume assessment in elderly patients with CHD;2.Age,time of anesthesia and intraoperative fluid speed were independent risk factors for perioperative B line increase in elderly patients with CHD.