Zhao Na, Xu Jin, Li Xiao-Guang, Walline Joseph Harold, Li Yi-Chong, Wang Lin, Zhao Guo-Sheng, Xu Ming-Jun
Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
World J Clin Cases. 2020 Apr 26;8(8):1444-1453. doi: 10.12998/wjcc.v8.i8.1444.
Very few studies have been published on the hemodynamic changes associated with spinal anesthesia induced with ropivacaine during cesarean deliveries in preeclamptic women.
To record and analyze hemodynamic data in women with preeclampsia undergoing cesarean delivery after spinal anesthesia induced with ropivacaine.
Ten eligible women with preeclampsia were enrolled in this prospective observational study. Spinal anesthesia was performed with 2.4 mL of 0.5% ropivacaine. Hemodynamic changes were then analyzed at multiple time points. The hemodynamic responses to vasopressor interventions and uterotonic agents, as well as maternal and neonatal outcomes were also recorded.
Stable hemodynamic trends were observed in this study. Cardiac output (CO) and stroke volume increased mildly during surgery. In contrast, mean arterial pressure and systemic vascular resistance showed a moderate decrease from induction until the end of surgery. Central venous pressure dramatically increased after delivery. Oxytocin administration was associated with the most significant hemodynamic fluctuations during surgery, namely, an increase in CO and heart rate. Phenylephrine intervention was only required in three patients, and caused an increase in mean arterial pressure and systemic vascular resistance along with a decrease in heart rate, stroke volume, and CO. No maternal and neonatal complications were observed during this study, except transient episodes of hypotension.
Spinal anesthesia for caesarian delivery with ropivacaine in women with preeclampsia is linked to modest hemodynamic changes of no clinical significance in this study. Careful cardiovascular monitoring is still recommended, particularly after the delivery of the fetus or the use of oxytocin.
关于在子痫前期妇女剖宫产期间，罗哌卡因诱导的脊髓麻醉相关血流动力学变化的研究发表得很少。
记录并分析子痫前期妇女在罗哌卡因诱导脊髓麻醉后行剖宫产时的血流动力学数据。
十名符合条件的子痫前期妇女纳入了这项前瞻性观察研究。使用2.4毫升0.5%的罗哌卡因进行脊髓麻醉。然后在多个时间点分析血流动力学变化。还记录了对血管升压药干预和宫缩剂的血流动力学反应，以及母婴结局。
本研究观察到血流动力学趋势稳定。手术期间心输出量（CO）和每搏输出量轻度增加。相比之下，从诱导到手术结束，平均动脉压和全身血管阻力中度下降。分娩后中心静脉压显著升高。手术期间，缩宫素给药与最显著的血流动力学波动相关，即CO和心率增加。仅三名患者需要去氧肾上腺素干预，导致平均动脉压和全身血管阻力增加，同时心率、每搏输出量和CO下降。除短暂性低血压发作外，本研究期间未观察到母婴并发症。
在本研究中，子痫前期妇女剖宫产使用罗哌卡因进行脊髓麻醉与无临床意义的适度血流动力学变化有关。仍建议进行仔细的心血管监测，尤其是在胎儿娩出后或使用缩宫素后。
