心率变异性指导下择期剖宫产蛛网膜下腔阻滞后严重低血压的预防性治疗。

Heart rate variability-guided prophylactic treatment of severe hypotension after subarachnoid block for elective cesarean delivery.

作者信息

Hanss Robert, Bein Berthold, Francksen Helga, Scherkl Wiebke, Bauer Martin, Doerges Volker, Steinfath Markus, Scholz Jens, Tonner Peter H

机构信息

Department of Anaesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.

出版信息

Anesthesiology. 2006 Apr;104(4):635-43. doi: 10.1097/00000542-200604000-00005.

DOI:10.1097/00000542-200604000-00005

PMID:16571956

Abstract

BACKGROUND

Baseline low-to-high frequency ratio (LF/HF) of heart rate variability predicted hypotension after subarachnoid block (SAB). LF/HF-guided treatment of hypotension with vasopressors or colloids was investigated.

METHODS

In 80 women scheduled to undergo cesarean delivery during SAB, LF/HF and systolic blood pressure (SBP) were analyzed. Patients were randomly assigned to a control group (n = 40) or a treatment group (n = 40). Control patients were assigned by their baseline LF/HF to one of two subgroups: LF/HF less than 2.5 or LF/HF greater than 2.5. Treatment patients with baseline LF/HF greater than 2.5 were treated with vasopressor infusion right after SAB (n = 20) or colloid prehydration until LF/HF decreased below 2.5 (n = 20). The incidences of hypotension (SBP < 80 mmHg) and hypertension (SBP > 140 mmHg) were investigated. LF/HF is presented as median and range, and SBP is presented as mean +/- SD.

RESULTS

Three of 17 control patients with low baseline LF/HF (1.7 [1.3/1.8]) demonstrated hypotension, and mean SBP remained stable (lowest SBP = 105 +/- 14 mmHg). In contrast, 20 of 23 control patients with high baseline LF/HF (3.8 [3.3/4.8]; P < 0.0001 vs. low baseline LF/HF) demonstrated hypotension after SAB: lowest SBP = 78 +/- 15 mmHg (P < 0.0001 vs. lowest SBP of control group with low baseline LF/HF). LF/HF-guided vasopressor therapy prevented hypotension in 19 of 20 patients: baseline SBP = 123 +/- 15 mmHg, lowest SBP = 116 +/- 17 mmHg. Mean prophylactic colloid infusion of 1,275 +/- 250 ml reduced elevated baseline LF/HF from 5.4 (4.1/7.5) to 1.3 (0.8/1.59) (P < 0.0001). Hypotension was prevented in 17 of 20 patients: baseline SBP = 115 +/- 13 mmHg, lowest SBP = 104 +/- 19 mmHg. No hypertensive episode was recognized.

CONCLUSIONS

LF/HF may be a tool to guide prophylactic therapy of patients at high risk for hypotension after SAB. Vasopressor therapy tended to be more effective compared with colloid prehydration.

摘要

背景

蛛网膜下腔阻滞（SAB）后心率变异性的基线低频与高频比值（LF/HF）可预测低血压。本研究探讨了基于LF/HF指导使用血管升压药或胶体治疗低血压的效果。

方法

选取80例行SAB剖宫产的女性，分析其LF/HF和收缩压（SBP）。患者随机分为对照组（n = 40）和治疗组（n = 40）。对照组患者根据其基线LF/HF分为两个亚组：LF/HF小于2.5或LF/HF大于2.5。基线LF/HF大于2.5的治疗组患者在SAB后立即接受血管升压药输注治疗（n = 20）或胶体预扩容治疗直至LF/HF降至2.5以下（n = 20）。观察低血压（SBP < 80 mmHg）和高血压（SBP > 140 mmHg）的发生率。LF/HF以中位数和范围表示，SBP以平均值±标准差表示。

结果

17例基线LF/HF较低（1.7 [1.3/1.8]）的对照组患者中有3例出现低血压，平均SBP保持稳定（最低SBP = 105 ± 14 mmHg）。相比之下，23例基线LF/HF较高（3.8 [3.3/4.8]；与基线LF/HF较低者相比，P < 0.0001）的对照组患者在SAB后有20例出现低血压：最低SBP = 78 ± 15 mmHg（与基线LF/HF较低对照组患者的最低SBP相比，P < 0.0001）。基于LF/HF指导的血管升压药治疗可预防20例患者中的19例发生低血压：基线SBP = 123 ± 15 mmHg，最低SBP = 116 ± 17 mmHg。平均预防性输注胶体1275 ± 250 ml可使升高的基线LF/HF从5.4（4.1/7.5）降至1.3（0.8/1.59）（P < 0.0001）。20例患者中有17例预防了低血压：基线SBP = 115 ± 13 mmHg，最低SBP = 104 ± 19 mmHg。未发现高血压发作。