Verdeyen J, Ory J P, Wyckmans W, Vandermeersch E, Jamaer L, Van Assche A
Department of Aneshesia, University Hospitals KUL, Leuven, Belgium.
Acta Anaesthesiol Belg. 2008;59(2):73-8.
Spinal hypotension (SH) is a common side effect of spinal anesthesia and may also occur after the surgical procedure. In this double-blinded, placebo-controlled, randomised clinical trial fifty patients undergoing transurethral prostatectomy under spinal anesthesia received 10 mg of ephedrine IV before being transferred from the operating table into their bed after the procedure, whereas fifty controls received saline IV. The number of per- and postoperative hypotensive episodes and vasopressor use, time delay between the administration of the study medication and the first hypotensive episode, level of spinal blockade at the start of surgery, pre- and postoperative hemoglobine and sodium concentration, cardiovascular co-morbidity and chronic medication were registered. There was no statistically significant difference in the incidence of postoperative hypotension between the two groups, but Poisson regression of the expected number of postoperative hypotensive episodes per patient showed a protective effect of ephedrine (p < 0.05). The occurence of peroperative hypotension was a risk factor for developing postoperative hypotension (p < 0.05). There was no statistically significant relation between age, level of spinal blockade, cardiovascular co-morbidity or biochemical parameters and the risk of developing per- or postoperative hypotension, except for a correlation between preoperative alpha-receptor blocking drugs and peroperative hypotension (p < 0.05). Postoperative hypotension (recorded incidence 31%) was almost as common as peroperative hypotension (recorded incidence 37%) and occurred as late as 190 minutes after the end of surgery. Ephedrine IV at the end of surgery reduced the number of postoperative hypotensive episodes per patient but did not reduce the overall incidence of postoperative SH.
脊髓性低血压（SH）是脊髓麻醉的常见副作用，也可能在手术后出现。在这项双盲、安慰剂对照、随机临床试验中，50例接受脊髓麻醉下经尿道前列腺切除术的患者在手术后从手术台转移到床上之前静脉注射10毫克麻黄碱，而50例对照组患者静脉注射生理盐水。记录围手术期和术后低血压发作次数、血管升压药使用情况、研究药物给药与首次低血压发作之间的时间延迟、手术开始时的脊髓阻滞水平、术前和术后血红蛋白及钠浓度、心血管合并症和慢性用药情况。两组术后低血压发生率无统计学显著差异，但对每位患者术后低血压发作预期次数的泊松回归显示麻黄碱具有保护作用（p<0.05）。术中低血压的发生是术后低血压发生的一个危险因素（p<0.05）。年龄、脊髓阻滞水平、心血管合并症或生化参数与围手术期或术后低血压发生风险之间无统计学显著关系，但术前α受体阻滞剂与术中低血压之间存在相关性（p<0.05）。术后低血压（记录发生率31%）几乎与术中低血压（记录发生率37%）一样常见，且在手术结束后190分钟才出现。手术结束时静脉注射麻黄碱减少了每位患者术后低血压发作次数，但未降低术后SH的总体发生率。
