Kulkarni Kalpana Rajendra, Naik Amruta Girish, Deshpande Sunetra Girish
Departments of Anesthesiology and Pain Management, D Y Patil Medical College, Kolhapur, Maharashtra, India.
Anesth Essays Res. 2016 Sep-Dec;10(3):637-642. doi: 10.4103/0259-1162.191118.
Spinal anesthesia is a preferred technique over general anesthesia for cesarean delivery. It avoids maternal airway related complications, aspiration and neonatal depression. However hypotension following spinal anesthesia can lead to decrease in uterine blood flow and neonatal hypoxia.
We aimed to evaluate the efficacy of 15 mL.kg- 1of crystalloid preloading versus prophylactic intravenous bolus of 10 mg ephedrine as an antihypotensive measure for cesarean section.
A prospective randomized double blind study was conducted in hundred ASA grade I/II parturient undergoing cesarean section, allocated to group (=50) who received preloading with ringer lactate 15 mL.kg- 1 over 20 minutes before spinal anesthesia and group E (=50) received intravenous bolus of 10mg ephedrine within one minute of spinal anesthesia with 10mg of hyperbaric bupivacaine 0.5% at L2-3/L3-4 level. They were monitored for incidences of hypotension, need of rescue doses of ephedrine, Apgar score and adverse events. Appropriate statistical tests were applied and < 0.05 was considered as significant.
Incidence of hypotension within 20 minutes of spinal anesthesia was significantly less in group E (28%) as compared to group (58%) and need of rescue doses were more in group P. Adverse events like nausea vomiting and shivering were less in group E. Apgar score were better in group E than in group delivered babies.
Prophylactic intravenous bolus of 10mg ephedrine with spinal injection is more effective in maintaining maternal hemodynamic stability and better neonatal outcome as compared to crystalloid preloading during cesarean delivery.
剖宫产时，脊髓麻醉是比全身麻醉更优选的技术。它可避免与产妇气道相关的并发症、误吸和新生儿抑制。然而，脊髓麻醉后低血压可导致子宫血流减少和新生儿缺氧。
我们旨在评估15 mL·kg⁻¹晶体液预负荷与预防性静脉推注10 mg麻黄碱作为剖宫产抗低血压措施的疗效。
对100例美国麻醉医师协会（ASA）I/II级剖宫产产妇进行前瞻性随机双盲研究，分为P组（n = 50），在脊髓麻醉前20分钟内接受15 mL·kg⁻¹乳酸林格液预负荷；E组（n = 50），在L2 - 3/L3 - 4水平用0.5%重比重布比卡因10 mg进行脊髓麻醉后1分钟内接受静脉推注10 mg麻黄碱。监测两组低血压发生率、麻黄碱抢救剂量需求、阿氏评分及不良事件。应用适当的统计学检验，P < 0.05被认为具有统计学意义。
脊髓麻醉后20分钟内，E组低血压发生率（28%）显著低于P组（58%），且P组麻黄碱抢救剂量需求更多。E组恶心呕吐和寒战等不良事件较少。E组分娩的婴儿阿氏评分优于P组。
剖宫产时，与晶体液预负荷相比，脊髓注射时预防性静脉推注10 mg麻黄碱在维持产妇血流动力学稳定和改善新生儿结局方面更有效。
