Accuracy of variation of carotid artery hemodynamic parameters combined with passive leg raising test in predicting SHS after spinal anesthesia in patients undergoing cesarean section / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the accuracy of variation of carotid artery hemodynamic parameters combined with passive leg raising (PLR) test in predicting supine hypotension syndrome (SHS) after spinal anesthesia in the patients undergoing cesarean section.Methods:Sixty-four parturients who were at full term with a singleton fetus, at 37-42 weeks of gestation, aged 18-40 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective cesarean section, were enrolled in this study.The variation of carotid artery diameter (&Delta;D), variation of velocity time integral (&Delta;VTI), and variation of carotid blood flow (&Delta;CBF) before and after PLR were measured using ultrasound.Patients were divided into SHS group and non-SHS group (NSHS group) according to whether SHS after spinal anesthesia occurred.Pearson correlation was used to analyze the correlation between &Delta;D, &Delta;VTI, &Delta;CBF and systolic blood pressure (SBP) after spinal anesthesia.The receiver operating characteristic curve was used to assess the accuracy of &Delta;D, &Delta;VTI and &Delta;CBF in predicting SHS. Results:&Delta;VTI was negatively correlated with SBP after spinal anesthesia ( r=-0.539, P<0.01), &Delta;CBF was negatively correlated with SBP after spinal anesthesia ( r=-0.475, P<0.05), and &Delta;D had no correlation with SBP after spinal anesthesia in group SHS ( P>0.05). The critical values of &Delta;CBF, &Delta;VTI, and &Delta;D combined with PLR in predicting SHS after spinal anesthesia were 15.5%, 10.1%, and 6.0%, respectively, the sensitivity was 92.9%, 57.1%, and 96.4%, respectively, and the specificity was 53.1%, 81.2%, and 75.0%, respectively, and the areas under the curve were 0.873, 0.681 and 0.846, respectively. Conclusion:The ultrasound-measured &Delta;CBF and &Delta;D of carotid artery combined with PLR can be used as a reliable method to predict SHS after spinal anesthesia in the patients undergoing cesarean section, and the &Delta;CBF combined with PLR has a higher accuracy.