Vetrugno Luigi, Dogareschi Teresa, Sassanelli Rossella, Orso Daniele, Seremet Ludmilla, Mattuzzi Lisa, Scapol Sara, Spasiano Alessandra, Cagnacci Angelo, Bove Tiziana
Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Via Colugna 50, 33100, Udine, Italy.
University-Hospital of S. M. Misericordia, Udine, Italy, 33100, P.le S. Maria della Misericordia n 15, Udine, Italy.
Ultrasound J. 2020 Mar 6;12(1):10. doi: 10.1186/s13089-020-00158-7.
Pregnancy-induced changes in cardiovascular status make women more susceptible to pulmonary edema. During cesarean section, to counterbalance the effect of hypotension caused by spinal anesthesia, anesthesiologists must choose between two fundamental approaches to maintain the hemodynamic state-intravenous fluids or vasopressors-and this choice will depend upon their particular opinions and experience. We aim to assess for any correlations between thoracic ultrasound A- and B-line artifacts, brain natriuretic peptide (BNP) levels, and the amount of intraoperative fluids administered.
From December 2016 to August 2018, at the University-Hospital of Udine, we enrolled 80 consecutive pregnant women undergoing cesarean section. We observed a statistically significant difference in the volume of fluids administered in the first 24 h (p = 0.035) between the patients presenting B-lines in at least one basal area of their thoracic ultrasound and patients with no evident B-lines (AUC 66.4%; IC 0.49-0.83). Dividing the population on whether their BNP levels were higher or less than 20 pg/mL, no statistically significant difference was revealed with regard to fluids administered in the first 24 h (p = 0.537).
Thoracic ultrasound is a non-invasive and easy-to-use tool for detecting fluid intolerance in pregnant women undergoing cesarean section. BNP levels were slow to rise following the cesarean section and did not show any clear correlation with fluid volumes administered.
妊娠引起的心血管状态变化使女性更容易发生肺水肿。在剖宫产手术中，为了抵消脊髓麻醉引起的低血压的影响，麻醉医生必须在两种维持血流动力学状态的基本方法之间做出选择——静脉输液或血管加压药——而这种选择将取决于他们的个人观点和经验。我们旨在评估胸部超声A线和B线伪像、脑钠肽（BNP）水平与术中输液量之间是否存在任何相关性。
2016年12月至2018年8月，在乌迪内大学医院，我们连续纳入了80例接受剖宫产手术的孕妇。我们观察到，在胸部超声至少一个基底区域出现B线的患者与没有明显B线的患者之间，前24小时的输液量存在统计学上的显著差异（p = 0.035）（AUC 66.4%；IC 0.49 - 0.83）。根据BNP水平高于或低于20 pg/mL对人群进行划分，在前24小时的输液量方面未发现统计学上的显著差异（p = 0.537）。
胸部超声是一种用于检测剖宫产孕妇液体不耐受的非侵入性且易于使用的工具。剖宫产术后BNP水平升高缓慢，且与输液量未显示出任何明显的相关性。
