Department of Anesthesiology, Rabin Medical Center-Beilinson Campus, Petach Tikvah, Israel.
Br J Anaesth. 2012 Dec;109(6):943-9. doi: 10.1093/bja/aes313. Epub 2012 Sep 10.
We designed a prospective observational study to assess the effect of preoperative anxiety on hypotension after spinal anaesthesia.
After IRB approval and signed informed consent, 100 healthy term parturients undergoing elective Caesarean delivery under spinal anaesthesia were enrolled. Direct psychological assessments of preoperative anxiety were verbal analogue scale (VAS) (0-10) anxiety score and State-Trait Anxiety Inventory questionnaire (STAI-s); salivary amylase was measured as an indirect physical assessment of anxiety. Direct and indirect anxiety data were transformed into ordinal groups for low, medium, and high anxiety (VAS: low 0-3, medium 4-6, high 7-10; STAI-s: low <40, medium 40-55, high >55; log(10) salivary amylase: low <3, medium 3-4, high >4). Spinal anaesthesia was performed using hyperbaric bupivacaine 10 mg and fentanyl 20 μg. All patients received i.v. crystalloid 500 ml prehydration and 500 ml cohydration. Hypotension was treated by standardized protocol (fluid bolus and ephedrine or phenylephrine depending on maternal heart rate). Systolic arterial pressure (SAP) was measured at baseline and every minute after spinal anaesthesia. The effect of low, medium, and high anxiety groups on the maximum percentage change in SAP (%ΔSAP) was assessed (one-way analysis of variance, Tukey's honestly significant difference).
Ninety-three patients were included in analysis. There was a significant effect of direct psychological measures of anxiety on %ΔSAP (VAS P=0.004; STAI-s P=0.048). There was a significant difference between low and high anxiety groups (VAS P=0.003; STAI-s P=0.038), but not between other anxiety groups. Salivary amylase did not correlate with %ΔSAP.
Preoperative anxiety assessed by VAS had a significant effect on hypotension after spinal anaesthesia.
我们设计了一项前瞻性观察研究，以评估术前焦虑对脊髓麻醉后低血压的影响。
在 IRB 批准并签署知情同意书后，纳入 100 名接受脊髓麻醉下择期剖宫产的健康足月产妇。术前焦虑的直接心理评估采用口述模拟量表（VAS）（0-10）焦虑评分和状态特质焦虑问卷（STAI-s）；唾液淀粉酶作为焦虑的间接生理评估进行测量。直接和间接焦虑数据转换为低、中、高焦虑的有序组（VAS：低 0-3，中 4-6，高 7-10；STAI-s：低<40，中 40-55，高>55；log（10）唾液淀粉酶：低<3，中 3-4，高>4）。脊髓麻醉采用 10mg 布比卡因和 20μg 芬太尼的重比重溶液。所有患者均接受静脉输液 500ml 预扩容和 500ml 持续扩容。低血压采用标准化方案（液体冲击和根据产妇心率选择麻黄碱或去氧肾上腺素）进行治疗。脊髓麻醉后每分钟测量收缩压（SAP）。评估低、中、高焦虑组对 SAP 最大百分比变化（%ΔSAP）的影响（单因素方差分析，Tukey Honestly Significant Difference）。
93 例患者纳入分析。焦虑的直接心理测量对%ΔSAP 有显著影响（VAS P=0.004；STAI-s P=0.048）。低和高焦虑组之间有显著差异（VAS P=0.003；STAI-s P=0.038），但其他焦虑组之间无差异。唾液淀粉酶与%ΔSAP 不相关。
VAS 评估的术前焦虑对脊髓麻醉后低血压有显著影响。
