腹内压对剖宫产单次脊麻感觉阻滞平面的影响：一项观察性研究。
The effect of intra-abdominal pressure on sensory block level of single-shot spinal anesthesia for cesarean section: an observational study.
作者信息
Ozkan Seyhan T, Orhan-Sungur M, Basaran B, Savran Karadeniz M, Demircan F, Xu Z, Sessler D I
机构信息
Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology, Capa Clinics, Istanbul, Turkey.
Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology, Capa Clinics, Istanbul, Turkey.
出版信息
Int J Obstet Anesth. 2015 Feb;24(1):35-40. doi: 10.1016/j.ijoa.2014.08.004. Epub 2014 Aug 27.
BACKGROUND
Increased intra-abdominal pressure in pregnancy is thought to affect intrathecal drug spread. However this assumption remains largely untested. The aim of this prospective study was to evaluate the association between intra-abdominal pressure and maximum sensory block level in parturients receiving spinal anesthesia for cesarean section.
METHODS
Parturients having elective cesarean section with single-shot spinal anesthesia using hyperbaric bupivacaine 12.5mg were included. Intra-abdominal pressure was measured via a bladder catheter after establishing a T4 sensory block and at the end of surgery in the supine position with 10° left lateral tilt. We recorded demographic data, descriptive characteristics of pregnancy, self-reported weight gain and weight of the newborn. As secondary outcomes, we evaluated onset of sensory block, maximum sensory block, motor block, number of hypotensive episodes, fluid and ephedrine requirements, time to first analgesic request, time to one-point recovery of motor block and side effects.
RESULTS
The median value of the maximum sensory block level was T2 in 117 parturients. Median [interquartile range] pre-incision and postoperative intra-abdominal pressure were 13 [11-16] and 9 [6-10]mmHg respectively. No association was observed between maximum sensory block level and pre-incision intra-abdominal pressure (P=0.83). Weight was associated with pre-incision intra-abdominal pressure with an estimated odds ratio of 1.04 per kg (99.4% CI: 1.00-1.08). There was a moderate correlation between pre-incision and postoperative intra-abdominal pressure with a Spearman correlation coefficient of 0.67 (99.5% CI: 0.5-0.79). There was no association between pre-incision intra-abdominal pressure and secondary outcomes.
CONCLUSIONS
In parturients, intra-abdominal pressure was not associated with spinal block spread, block onset time, recovery or side effects.
背景
孕期腹内压升高被认为会影响鞘内药物扩散。然而，这一假设在很大程度上仍未得到验证。这项前瞻性研究的目的是评估接受剖宫产脊髓麻醉的产妇腹内压与最大感觉阻滞平面之间的关联。
方法
纳入接受单次脊髓麻醉、使用12.5mg重比重布比卡因进行择期剖宫产的产妇。在T4感觉阻滞建立后以及手术结束时，产妇取仰卧位并向左倾斜10°，通过膀胱导管测量腹内压。我们记录了人口统计学数据、妊娠的描述性特征、自我报告的体重增加情况和新生儿体重。作为次要结局，我们评估了感觉阻滞的起效时间、最大感觉阻滞平面、运动阻滞、低血压发作次数、液体和麻黄碱需求量、首次要求镇痛的时间、运动阻滞单点恢复时间以及副作用。
结果
117例产妇的最大感觉阻滞平面中位数为T2。切口前和术后腹内压的中位数[四分位间距]分别为13[11 - 16]mmHg和9[6 - 10]mmHg。未观察到最大感觉阻滞平面与切口前腹内压之间存在关联（P = 0.83）。体重与切口前腹内压相关，估计比值比为每千克1.04（99.4%可信区间：1.00 - 1.08）。切口前和术后腹内压之间存在中度相关性，Spearman相关系数为0.67（99.5%可信区间：0.5 - 0.79）。切口前腹内压与次要结局之间无关联。
结论
在产妇中，腹内压与脊髓阻滞扩散、阻滞起效时间、恢复或副作用无关。
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