Application Of Collapse Index Of Inferior Vena Cava In Emergency Painless Gastroscopic Hemostasis

Objective:To investigate the influence of bedside ultrasound measurement of inferior vena cava collapse index on hemodynamics and anesthesia recovery time of patients with emergency upper gastrointestinal bleeding during painless gastroscopic hemostasis guided by preoperative fluid replenishment.Methods:From December 1,2021 to December 1,2022,100 patients with upper gastrointestinal hemorrhage who met the inclusion and exclusion criteria and underwent gastroscopic hemostasis under intravenous general anesthesia with propofol combined with sufentanil in our hospital were selected.There were 81 males and 19 females,aged 20-80 years,body mass index(BMI)18-25 kg/m2.All the patients were classified as American Society of Anesthesiologists(ASA)ⅰ-ⅲ grade and New York Heart Association(NYHA)ⅰ-ⅱ grade.The patients were randomly divided into two groups,50 cases in each group.Experimental group(group S):the Inferior Vena Cava Collapse Index(IVC-CI)was measured by ultrasound to evaluate the blood volume,and the infusion was guided by the results of IVC-CI to maintain IVC-CI≤43%.The control group(group D)was given routine infusion according to preoperative fasting and water deprivation time.General anesthesia was induced by propofol combined with sufentanil in both groups,and the depth of anesthesia(Narcotrend)was maintained atD2 stage(NT value 37-46,conventional anesthesia depth)during gastroscopic hemostasis.The mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(SPO2),partial pressure of oxygen(PO2),lactic acid(Lac),hemoglobin(Hb)and hematocrit(Hc)were recorded at the time of entering the endoscopy room(T0),before anesthesia induction(T1),5 minutes after anesthesia(T2)and 5 minutes after surgery(T3)t),IVC-CI,the amount of infusion before anesthesia induction and the total amount of infusion after anesthesia induction,and the time of awakening call to open eyes.Results:1.General conditions:there was no significant difference in gender,age,height,weight,ASA grade and NYHAgrade between the two groups(P>0.05).2.Hemodynamics:compared with group D,the mean arterial pressure in group S was significantly higher than that in group D at T1(P<0.05),and the mean arterial pressure in group S was significantly higher than that in group D at T2 and T3(P<0.01)The heart rate of group S was significantly lower than that of group D at T1,T2 and T3(P<0.01).3.Awakening time:compared with group D,the time of awakening call to open eyes in group S was significantly shorter(P<0.01).4.Blood gas indexes:in the monitoring of arterial blood lactic acid(Lac),the value of blood lactic acid in group S was significantly lower than that in group D at T2 and T3,and the difference was statistically significant(P<0.01).There was no significant difference between group S and group D in the monitoring of arterial oxygen partial pressure(PO2),hemoglobin content(Hb)and hematocrit(Hct)(P>0.05).Conclusions:1.The application of bedside ultrasound to measure IVC-CI and guide preoperative infusion is conducive to stable intraoperative hemodynamics of patients undergoing painless gastroscopic hemostasis for acute upper gastrointestinal bleeding,2.The application of bedside ultrasound measurement of IVC-CI and guidance of preoperative infusion can shorten the anesthesia recovery time of patients undergoing painless gastroscopy for acute upper gastrointestinal bleeding.