单侧手术中T10感觉平面以下单侧脊髓麻醉与硬膜外麻醉血流动力学变化的比较：一项双盲随机临床试验
Comparison of Hemodynamic Changes in Unilateral Spinal Anesthesia Versus Epidural Anesthesia Below the T10 Sensory Level in Unilateral Surgeries: a Double-Blind Randomized Clinical Trial.
作者信息
Kiasari Alieh Zamani, Babaei Anahita, Alipour Abbas, Motevalli Shima, Baradari Afshin Gholipour
机构信息
Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Epidemiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
出版信息
Med Arch. 2017 Aug;71(4):274-279. doi: 10.5455/medarh.2017.71.274-279.
BACKGROUND
Unilateral spinal anesthesia is used to limit the spread of block. The aim of the present study was to compare hemodynamic changes and complications in unilateral spinal anesthesia and epidural anesthesia below the T10 sensory level in unilateral surgeries.
MATERIALS AND METHODS
In this double-blind randomized clinical trial in total 120 patients were randomly divided into a unilateral spinal anesthesia group (Group S) and an epidural anesthesia group (Group E). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rates were measured before and immediately after the administration of spinal or epidural anesthesia and then at 5-, 10-, 15-, 20-, 25-, and 30-min intervals. The rates of prescribed ephedrine and intraoperative respiratory arrest were recorded, in addition to postoperative nausea and vomiting, puncture headaches, and back pain during the first 24 h after the surgery.
RESULTS
SBP, DBP, and MAP values initially showed a statistically significant downward trend in both groups (p = 0.001). The prevalence of hypotension in Group S was lower than in Group E, and the observed difference was statistically significant (p < 0.0001). The mean heart rate change in Group E was greater than in Group S, although the difference was not statistically significant (p = 0.68). The incidence of prescribed ephedrine in response to a critical hemodynamic situation was 5.1% (n = 3) and 75% (n = 42) in Group S and Group E, respectively (p = 0.0001). The incidence of headaches, back pain, and nausea/vomiting was 15.3%, 15.3%, and 10.2% in Group S and 1.8%, 30.4%, and 5.4% in Group E (p = 0.017, 0.07, and 0.49, respectively).
CONCLUSION
Hemodynamic stability, reduced administration of ephedrine, a simple, low-cost technique, and adequate sensory and motor block are major advantages of unilateral spinal anesthesia.
背景
单侧脊髓麻醉用于限制阻滞范围。本研究的目的是比较单侧手术中T10感觉平面以下单侧脊髓麻醉和硬膜外麻醉时的血流动力学变化及并发症。
材料与方法
在这项双盲随机临床试验中，总共120例患者被随机分为单侧脊髓麻醉组（S组）和硬膜外麻醉组（E组）。在脊髓或硬膜外麻醉给药前及给药后即刻，然后每隔5、10、15、20、25和30分钟测量收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和心率。记录麻黄碱的使用频率和术中呼吸骤停情况，以及术后24小时内的恶心呕吐、穿刺后头痛和背痛情况。
结果
两组的SBP、DBP和MAP值最初均呈现出具有统计学意义的下降趋势（p = 0.001）。S组低血压的发生率低于E组，观察到的差异具有统计学意义（p < 0.0001）。E组的平均心率变化大于S组，尽管差异无统计学意义（p = 0.68）。在应对危急血流动力学情况时，S组和E组麻黄碱的使用发生率分别为5.1%（n = 3）和75%（n = 42）（p = 0.0001）。S组头痛、背痛和恶心/呕吐的发生率分别为15.3%、15.3%和10.2%，E组分别为1.8%、30.4%和5.4%（分别为p = 0.017、0.07和0.49）。
结论
血流动力学稳定性、麻黄碱使用量减少、技术简单成本低以及感觉和运动阻滞充分是单侧脊髓麻醉的主要优点。
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