Hasanin Ahmed, Soryal Remoon, Kaddah Tarek, Raouf Sabah Abdel, Abdelwahab Yaser, Elshafaei Khaled, Elsayad Mohamed, Abdelhamid Bassant, Fouad Reham, Mahmoud Doaa, Hassabelnaby Yasmin
Department of anesthesia and critical care, Faculty of medicine, Cairo University, 01 elsarayah Street, Elmanyal, Cairo, Egypt.
Department of obstetrics and gynecology, Cairo University, Cairo, Egypt.
BMC Anesthesiol. 2018 Jan 15;18(1):8. doi: 10.1186/s12871-018-0473-0.
Post-spinal hypotension is a common maternal complication during cesarean delivery. Aortocaval compression by the gravid uterus has been assumed as a precipitating factor for post-spinal hypotension. The role of left lateral tilting position in improving maternal cardiac output after subarachnoid block (SAB) is unclear. The aim of this work is to investigate the effect of left lateral tilting on maternal hemodynamics after SAB.
A prospective observational study was conducted including 105 full term pregnant women scheduled for cesarean delivery. Mean arterial pressure, heart rate, cardiac output (measured by electrical cardiometry), stroke volume, and systemic vascular resistance were recorded in three positions (supine, 15, and 30 left lateral positions) before SAB, after SAB, and after delivery of the fetus.
Before SAB, no significant hemodynamic changes were reported with left lateral tilting. A significant decrease was reported in mean arterial pressure, cardiac output, stroke volume, and systemic vascular resistance after SAB (in supine position). When performing left lateral tilting, there was an increase in cardiac output, heart rate, and mean arterial pressure. No difference was reported between the two tilt angles (15 and 30).
Changing position of full term pregnant woman after SAB from supine to left lateral tilted position results increased cardiac output and mean arterial pressure. There is no difference between the two tilt angles (15 and 30).
clinicaltrials.gov ( NCT02828176 ) retrospectively registered.
脊柱麻醉后低血压是剖宫产术中常见的产妇并发症。妊娠子宫对腹主动脉和下腔静脉的压迫被认为是脊柱麻醉后低血压的一个促发因素。蛛网膜下腔阻滞（SAB）后左侧卧位对改善产妇心输出量的作用尚不清楚。本研究的目的是探讨左侧卧位对SAB后产妇血流动力学的影响。
进行一项前瞻性观察性研究，纳入105例计划行剖宫产的足月孕妇。在SAB前、SAB后及胎儿娩出后，记录三个体位（仰卧位、左侧卧位15°和左侧卧位30°）时的平均动脉压、心率、心输出量（通过心电描记法测量）、每搏输出量和全身血管阻力。
SAB前，左侧卧位未报告有显著的血流动力学变化。SAB后（仰卧位），平均动脉压、心输出量、每搏输出量和全身血管阻力显著下降。当改为左侧卧位时，心输出量、心率和平均动脉压增加。两个倾斜角度（15°和30°）之间未报告有差异。
SAB后足月孕妇体位从仰卧位改为左侧卧位可增加心输出量和平均动脉压。两个倾斜角度（15°和30°）之间无差异。
clinicaltrials.gov（NCT02828176），回顾性注册。
