Clinical Study Of Inferior Vena Cava And Subclavian Vein Cross-sectional Area Ultrasonography To Predict Hypotension After Induction

Objective:To investigate the clinical value of ultrasonic measurement of cross-sectional area of the inferior vena cava(IVC)and subclavian vein(SCV)in predicting hypotension during induction.Methods:A total of 159 selective operation patients,meeting the inclusion criteria,were selected from the Department of Anesthesiology of Wuhan Union Medical College Hospital from July 2017 to December 2017.The maximum inferior vena cava area(SIVCmax)and the minimum inferior vena cava area(SIVCmin),the maximum inferior vena cava diameter(DIVCmax)and the minimum inferior vena cava diameter(DIVCmin);Maximum subclavian vein area(SSCVmax)and Minimum subclavian vein area(SSCVmin),Maximum subclavian vein diameter(DSCVmax)and minimum subclavian vein diameter(DSCVmin);and calculate the Collapsibility index of inferior vena cava area(CIsivc)and Collapsibility index of inferior vena cava diameter(CIdivc),the cross-sectional area of the subclavian vein.Collapsibility index of subclavian vein area(CIsscv)and Collapsibility index of subclavian vein diameter(CIdscv)were measured preoperatively.Before induction,mean blood pressure(MAP)was recorded.After induction,MBP was recorded until surgery.Hypotension was defined as greater than 25%decrease in MBP from baseline or MBP less than 60 mmHg.Receiver operating characteristic curve analysis with gray zone approach were used.Results:?IVC diameter scanning was successful in 91.19%of patients.IVC area scanning was successful in 82.39%of patients.SCV diameter scanning was successful in 96.23%of patients.SCV area scanning was successful in 98.11%of patients.There were 79 patients developed hypotension after induction.?Patients who developed hypotension had a smaller DIVCmax(p<0.01)and SIVCmax(p<0.01)and had larger CIdivc(p<0.01),CIsivc(p<0.01),CIdscv(p<0.05)and CIsscv(p<0.05).?There was a low association between the decreasesin MAP after induction and the DIVCmax(r=-0.474);There was a significant association between the decreasesin MAP after induction and SIVCmax(r=-0.565),CIdivc(r=0.530),and CIsivc(r=0.504).There was a weak association between the decreasesin MAP after induction and the SCV measurements.?The ROC cure analysis for predicting hypotrnsion after induction when using the DIVCmax?SIVCmax,CIdivc and CIsivc as the AUC was 0.852(0.780?0.924),0.904(0.852?0.957),0.885(0.821?0.950)and 0.919(0.865?0.972);The optimal cuto value of DIVCmax?SIVCmax,CIdivc and CIsivc were 1.849cm?2.182cm2?33.6%?40.6%.The ROC cure analysis without clinical value for predicting hypotrnsion after induction when using the DSCVmax?SSCVmax?CIdscv?CIsscv were 0.588?0.536?0.621?0.591.Conclusion:Preoperative ultrasound IVC measurement was a reliable predictor of hypotension after induction of general anesthesia.DIVCmax and SIVCmax smaller than 1.849cm and 2.182cm2 were the threshold;CIdivc and CIsivc greater than 33.6%and 40.6%were the threshold.CIsivc has the highest prediction accuracy and the predicted value of the subclavian vein has no clinical significance.