关键词: 经胸超声； 容量评估； 心功能评估； 急诊手术； 老年病人； 麻醉管理

Abstract: Objective To explore the application value of volume and cardiac function assessment based on transthoracic ultrasound for emergency surgery and anesthesia management in elderly patients. Methods A total of 360 elderly patients scheduled for emergency surgery in our hospital from March 2022 to March 2025 were selected as the research subjects.They were divided into an observation group and a control group with 180 cases in each group using the computer random number table method.The observation group received volume and cardiac function assessment via transthoracic ultrasound and transesophageal ultrasound to guide anesthesia management,while the control group was given routine anesthesia management.The two groups were compared in terms of hemodynamic indicators at different time points [including mean arterial pressure (MAP) and heart rate (HR) before anesthesia induction,at the start of surgery and before leaving the operating room],clinical related indicators (including operation time,intraoperative fluid intake,intraoperative urine output and dosage of vasoactive drugs),imaging and ultrasound related indicators [including the detection rate of abnormalities such as pleural effusion,pneumothorax and abdominopelvic effusion,as well as parasternal left ventricular end-diastolic area (LVEDA),inferior vena cava diameter (IVC),right ventricular end-diastolic area (RVEDA) and tricuspid annular plane systolic excursion (TAPSE)],and postoperative related indicators (postoperative extubation time,ICU admission rate,complication rate and total hospitalization cost). Results There was no statistically significant difference in MAP and HR between the two groups before anesthesia induction (P>0.05).At the start of surgery and before leaving the operating room,the MAP of the observation group [(86.58±5.74) mmHg and (88.25±5.96) mmHg] was higher than that of the control group [(82.35±6.18) mmHg and (84.15±6.27) mmHg],and the HR [(98.65±8.74) beats/min and (102.36±9.12) beats/min] was lower than that of the control group [(105.82±9.21) beats/min and (108.75±9.58) beats/min],with statistically significant differences (P<0.05).The intraoperative fluid intake [(1 851.35±325.68) ml] and dosage of vasoactive drugs [5.23 (3.28,6.81) mg] in the observation group were lower than those in the control group [(2 140.73±358.24) ml and 8.65 (6.47,10.74) mg],while the urine output [(425.68±102.35) ml] was higher than that in the control group [(368.95±92.74) ml] (P<0.05).There was no statistically significant difference in operation time between the two groups (P>0.05).The total detection rate of abnormalities such as pleural effusion,pneumothorax and abdominopelvic effusion in the observation group was significantly higher than that in the control group (31.11% vs. 19.44%,P<0.05).There were no statistically significant differences in parasternal LVEDA,IVC,RVEDA and TAPSE at 5 minutes after intraoperative ultrasound monitoring and before leaving the operating room between the two groups(P>0.05).The postoperative extubation time [(6.35±2.18) h] of the observation group was shorter than that of the control group [(8.69±2.51) h],the postoperative ICU admission rate (6.67% vs. 15.56%) and complication rate (5.56% vs. 13.89%) were lower than those of the control group,and the total hospitalization cost [(35 291.74±5 242.27) yuan] was less than that of the control group [(43 918.80±6 215.58) yuan] (P<0.05). Conclusion The application of transthoracic ultrasound-based volume and cardiac function assessment for emergency surgery and anesthesia management in elderly patients can effectively maintain intraoperative hemodynamic stability,improve the detection rate of abnormalities,reduce intraoperative fluid intake and the use of vasoactive drugs,shorten postoperative extubation time,and decrease postoperative complication rate and hospitalization cost.

Key words: transthoracic ultrasound; volume assessment; cardiac function assessment; emergency surgery; elderly patients; anesthesia management