Jabalameli Mitra, Soltani Hassan Ali, Hashemi Jalal, Behdad Shekoofe, Soleimani Bahram
Department of Anesthesiology, Anesthesiology and Critical Care Research center, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2012;1:36. doi: 10.4103/2277-9175.100129. Epub 2012 Aug 28.
The benefit of prophylactic combination therapy using crystalloid and colloid preload with ephedrine has not been cleared to prevent maternal hypotension after spinal anesthesia at cesarean delivery. This study evaluated the efficacy of three combinational methods to prevent hypotension following spinal anesthesia.
In this prospective double blind trial, 150 candidates of elective cesarean delivery under spinal anesthesia were randomly allocated to three treatment groups; 1---Ringer's Lactate (RL) solution (15 ml/kg) plus Hemaxel (7 ml/kg) preload, 2---RL solution (15 ml/kg) preload plus ephedrine (15 mg, IV, bolus), 3---Hemaxel (7 ml/kg) preload plus ephedrine (15 mg, IV, bolus). Maternal hemodynamic changes during 60 min after spinal injection, nausea/vomiting, and neonatal condition were compared among the groups.
The cumulative incidence of hypotension was 44%, 40%, and 46% in groups 1 to 3, respectively. There were not significant differences in supplementary ephedrine requirement among groups which received or among groups which did not receive prophylactic ephedrine. Groups were not different in the incidence of hypertension and nausea or vomiting. There were no significant differences among groups in Apgar scores at 1 or 5 min and umbilical artery PH.
Combination of preventive methods decreased the occurrence of hypotension following spinal anesthesia to an acceptable level. Overall, the most effective method was a combination of crystalloid preload with ephedrine.
剖宫产脊髓麻醉后，使用晶体液和胶体液预负荷联合麻黄碱进行预防性联合治疗对预防产妇低血压的益处尚未明确。本研究评估了三种联合方法预防脊髓麻醉后低血压的疗效。
在这项前瞻性双盲试验中，150例择期剖宫产脊髓麻醉候选者被随机分为三个治疗组；1组——乳酸林格氏液（RL）（15 ml/kg）加贺斯（7 ml/kg）预负荷；2组——RL溶液（15 ml/kg）预负荷加麻黄碱（15 mg，静脉推注）；3组——贺斯（7 ml/kg）预负荷加麻黄碱（15 mg，静脉推注）。比较各组脊髓注射后60分钟内的产妇血流动力学变化、恶心/呕吐情况及新生儿状况。
1至3组低血压的累积发生率分别为44%、40%和46%。接受预防性麻黄碱的组与未接受预防性麻黄碱的组在补充麻黄碱需求方面无显著差异。各组高血压、恶心或呕吐的发生率无差异。各组在1分钟或5分钟时的阿氏评分及脐动脉pH值无显著差异。
联合预防方法可将脊髓麻醉后低血压的发生率降至可接受水平。总体而言，最有效的方法是晶体液预负荷与麻黄碱联合使用。
