Ferré Fabrice, Delmas Clément, Carrié Didier, Cognet Thomas, Lairez Olivier, Minville Vincent
Department of Anesthesiology and Critical Care Medicine, Toulouse University Hospital, Toulouse, France.
Department of Cardiology, Department of Cardiac Imaging Center; Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France.
Turk J Anaesthesiol Reanim. 2018 Aug;46(4):268-271. doi: 10.5152/TJAR.2018.48753. Epub 2018 Jun 25.
Hypotension frequently occurs during spinal anaesthesia (SA), especially in the elderly. This side effect could have a cardiac component per se (myocardial contractility impairment). Two-dimensional (2D) strain and strain rate imaging are new echocardiographic methods allowing an accurate assessment of myocardial function by quantifying myocardial deformation. Allowing quantification of minor myocardial dysfunction not detectable by standard echocardiography, strain imaging could bring new perspective on the cardiac effect of SA. Our objective was to evaluate the effects of SA on left ventricular function assessed by 2D strain echocardiography.
In this prospective observational study, we enrolled 20 patients older than 60 years, who underwent elective lower-limb surgery under SA. Myocardial strain imaging were collected before and 20 minutes after SA (injection of 10 mg of isobaric bupivacaine with 5 μg of sufentanil).
We observed an increase in global longitudinal reconnoitering (Δ-0.2±0.3% s; p<0.005), whereas left ventricular ejection fraction was not modified by SA.
This slight increase in myocardial contractility could be an adaptive mechanism to compensate the preload decrease and limit the blood pressure drop.
低血压在脊髓麻醉（SA）期间经常发生，尤其是在老年人中。这种副作用本身可能有心脏方面的因素（心肌收缩力受损）。二维（2D）应变和应变率成像技术是新的超声心动图方法，可通过量化心肌变形来准确评估心肌功能。应变成像技术能够量化标准超声心动图检测不到的轻微心肌功能障碍，可为脊髓麻醉对心脏的影响带来新的见解。我们的目的是通过二维应变超声心动图评估脊髓麻醉对左心室功能的影响。
在这项前瞻性观察研究中，我们纳入了20名年龄大于60岁、在脊髓麻醉下接受择期下肢手术的患者。在脊髓麻醉前（注射10mg等比重布比卡因与5μg舒芬太尼）和脊髓麻醉后20分钟采集心肌应变成像。
我们观察到整体纵向应变增加（Δ - 0.2±0.3% s；p<0.005），而脊髓麻醉并未改变左心室射血分数。
心肌收缩力的这种轻微增加可能是一种适应性机制，以补偿前负荷降低并限制血压下降。
