Ławicka Marzena, Małek Andrzej, Antczak Damian, Wajlonis Anita, Owczuk Radosław
Department of Anaesthesiology and Intensive Therapy, F. Ceynowa Specialist Hospital in Wejherowo, Poland.
Anaesthesiol Intensive Ther. 2015;47(4):303-8. doi: 10.5603/AIT.2015.0048.
Unfavourable circulatory system conditions have been observed in many patients with spinal anaesthesia. The most frequent symptoms include a decrease in blood pressure and, less frequently, bradycardia. The appearance of unfavourable consequences of spinal anaesthesia might be related to the initial status of the patient's circulatory system. The aim of this study was to establish the possibility of predicting unfavourable circulatory consequences (hypotension, bradycardia) following spinal anaesthesia, based on non-invasive haemodynamic assessment with a Nexfin device.
This prospective study included 100 18-60-year-old ASA I or II planned spinal anaesthesia patients. The initial hemodynamic parameters were assessed with a Nexfin monitor. Anaesthesia was performed with 3-3.5 mL of a 0,5% hyperbaric bupivacaine solution. Within 20 min after the administration of anaesthesia, the arterial blood pressure values, heart rate, sensory blockade level, and motoric blockade level were recorded in 5-min intervals. Hypotension was classified by a decrease of SAP < 90 mm Hg and/or the decrease of the SAP ≥ 20% initial value. Logistic regression was used to determine the independent predictors of hypotension resulting from a spinal blockade.
The development of hypotension and bradycardia was observed in 39 and 2%, respectively, of the patients. The patients who developed hypotension differed significantly from those who did not develop this symptom, with the main difference being the body mass and the assessment on the ASA scale. The patients who developed hypotension after spinal anaesthesia differed significantly in the initial hemodynamic parameters (SAP, MAP, SVRI). The following two independent risk factors for hypotension were isolated: the mean arterial pressure (OR 1.04; 95% CI: 1.005-1.076) and the systemic vascular resistance index (OR 1.109; 95% CI: 1.021-1.204).
Nexfin-based non-invasive haemodynamic monitoring might be helpful in the identification of individuals with a high risk of hypotension following spinal blockade.
许多接受脊髓麻醉的患者出现了不良循环系统状况。最常见的症状包括血压下降，较少见的是心动过缓。脊髓麻醉不良后果的出现可能与患者循环系统的初始状态有关。本研究的目的是基于使用Nexfin设备进行的非侵入性血流动力学评估，确定预测脊髓麻醉后不良循环后果（低血压、心动过缓）的可能性。
这项前瞻性研究纳入了100例年龄在18至60岁、计划接受脊髓麻醉的ASA I或II级患者。使用Nexfin监测仪评估初始血流动力学参数。采用3 - 3.5 mL的0.5%重比重布比卡因溶液进行麻醉。麻醉给药后20分钟内，每隔5分钟记录动脉血压值、心率、感觉阻滞平面和运动阻滞平面。低血压的定义为收缩压下降<90 mmHg和/或收缩压下降≥初始值的20%。采用逻辑回归确定脊髓阻滞导致低血压的独立预测因素。
分别有39%和2%的患者出现了低血压和心动过缓。出现低血压的患者与未出现该症状的患者有显著差异，主要区别在于体重和ASA分级评估。脊髓麻醉后出现低血压的患者在初始血流动力学参数（收缩压、平均动脉压、全身血管阻力指数）方面有显著差异。分离出以下两个低血压的独立危险因素：平均动脉压（OR 1.04；95% CI：1.005 - 1.076）和全身血管阻力指数（OR 1.109；95% CI：1.021 - 1.204）。
基于Nexfin的非侵入性血流动力学监测可能有助于识别脊髓阻滞后发生低血压高风险的个体。
