Ronenson A M, Sitkin S I, Savel'eva Iu V
Anesteziol Reanimatol. 2014 Jul-Aug;59(4):26-9.
It is common knowledge that an increase of intra-abdomninal pressure (lAP) causes a decrease in the volume of cerebrospinal fluid in the lumbar and lower thoracic region, which may contribute to the development of more high spinal block. There is currently no research devoted to studying the impact of intra-abdominal pressure in pregnancy on the development of high spinal blockade.
To investigate effects of intra-abdominal pressure in pregnancy on the development of spinal blockade and incidence of hypotension during cesarean section.
170 pregnant women with gestational age 38-40 weeks were included in the randomized, blinded, controlled study. All the women received elective cesarean section under spinal anesthesia (SA). Pregnant women w|,ere divided into two groups of 85 females each. In the first group, the anesthesiologist did not know the value of lAP and used the dose of local anesthetic focusing on height, weight, and according to his own experience. In the second group, an anesthesiologist corrected dose of local anesthetic depending on the lAP and also considered the height and weight of a woman.
In 9.2% of women, lAP was less than 11 mmHg (physiologically normal), in 49%--from 12 to 15 mmHg (degree I of intra-abdominal hypertension (IAH)), in 40.3%--from 16 to 20 mmHg (degree II of IAH), in 1.5%--from 21 to 25 mmHg (degree III of IAH). In the first group, the incidence of high spinal block (above Th4) and incidence of arterial hypotension (systolic blood pressure under 90 mm.Hg) was two times higher than in the second group (p<0.01).
Intra-abdominal hypertension in pregnant women contributed to the development of high spinal block and hypotension. To prevent these complications, we recommend decreasing the dose of local anesthetic with use of the Scale of the Risk of developing high spinal block in pregnant.
众所周知，腹内压升高会导致腰椎和下胸部区域脑脊液体积减少，这可能会促使更高位脊髓阻滞的发生。目前尚无专门研究妊娠腹内压对高位脊髓阻滞发展的影响。
探讨妊娠腹内压对剖宫产术中脊髓阻滞发展及低血压发生率的影响。
170例孕龄38 - 40周的孕妇纳入随机、双盲、对照研究。所有孕妇均在脊髓麻醉（SA）下接受择期剖宫产。孕妇被分为两组，每组85名女性。第一组，麻醉医生不知道腹内压值，根据身高、体重并依据自身经验使用局部麻醉药剂量。第二组，麻醉医生根据腹内压调整局部麻醉药剂量，同时考虑孕妇的身高和体重。
9.2%的女性腹内压低于11 mmHg（生理正常），49%为12至15 mmHg（腹内高压（IAH）I度），40.3%为16至20 mmHg（IAH II度），1.5%为21至25 mmHg（IAH III度）。第一组高位脊髓阻滞（胸4以上）发生率和动脉低血压（收缩压低于90 mmHg）发生率比第二组高两倍（p<0.01）。
孕妇腹内高压促使高位脊髓阻滞和低血压的发生。为预防这些并发症，我们建议使用妊娠高位脊髓阻滞发生风险量表来减少局部麻醉药剂量。
