Tan H S, Gan Y T, Tan E C, Nagarajan S, Sultana R, Han N L R, Sia A T H, Sng B L
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
Duke-NUS Medical School, Singapore.
Int J Obstet Anesth. 2020 Nov;44:3-12. doi: 10.1016/j.ijoa.2020.06.005. Epub 2020 Jun 27.
Unless prevented, hypotension occurs in up to 80% of normotensive women undergoing spinal anaesthesia for caesarean delivery. Renin-angiotensin-aldosterone system genetic polymorphisms have been associated with hypertensive disease, but few studies investigated effects on blood pressure regulation under spinal anaesthesia. We postulated that these polymorphisms increased vasodilation and maternal hypotension during spinal anaesthesia.
A retrospective secondary analysis of data from four prospective trials with similar inclusion/exclusion criteria evaluating phenylephrine/ephedrine delivery systems during spinal anaesthesia for elective caesarean delivery. Angiotensin type-1 receptor (AT1R) (A1166C), angiotensin-converting enzyme (ACE) (I/D), and aldosterone synthase CYP11B2 (C344T) polymorphisms were identified from stored specimens. The associations between the polymorphisms and hypotension (systolic blood pressure <80% of baseline), and vasopressor use, were determined by univariable and multivariable regression.
Of 556 patients, 378 (68.0%) had hypotension. The AC/CC genotypes of AT1R (A1166C) were associated with hypotension by univariable analysis (OR 2.70, 95% CI 1.38 to 5.28, P=0.004]) and multivariable analysis (OR 3.65, [95% CI 1.68 to 7.94, P=0.004]) after adjustment for age, race, intravenous fluid volume, and block height. No difference in vasopressor use or adverse maternal or fetal outcomes were noted. Baseline characteristics were similar, with the exception of higher baseline blood pressure, block height, and intravenous fluid volume in the hypotensive group. There was no significant association between ACE and CYP11B2 polymorphisms and hypotension.
AC/CC genotypes of AT1R (A1166C) polymorphism were associated with maternal hypotension under spinal anaesthesia for caesarean delivery. An association with cardiovascular indices and high-risk parturients should be examined.
除非采取预防措施，在接受剖宫产脊髓麻醉的正常血压女性中，高达80%会发生低血压。肾素 - 血管紧张素 - 醛固酮系统基因多态性与高血压疾病有关，但很少有研究调查其对脊髓麻醉下血压调节的影响。我们推测这些多态性会增加脊髓麻醉期间的血管舒张和产妇低血压。
对四项前瞻性试验的数据进行回顾性二次分析，这些试验具有相似的纳入/排除标准，评估择期剖宫产脊髓麻醉期间去氧肾上腺素/麻黄碱给药系统。从储存的标本中鉴定血管紧张素1型受体（AT1R）（A1166C）、血管紧张素转换酶（ACE）（I/D）和醛固酮合酶CYP11B2（C344T）多态性。通过单变量和多变量回归确定多态性与低血压（收缩压<基线的80%）和血管升压药使用之间的关联。
556例患者中，378例（68.0%）发生低血压。在对年龄、种族、静脉输液量和阻滞平面高度进行调整后，AT1R（A1166C）的AC/CC基因型通过单变量分析（OR 2.70，95%CI 1.38至5.28，P = 0.004）和多变量分析（OR 3.65，[95%CI 1.68至7.94，P = 0.004]）与低血压相关。血管升压药使用或产妇及胎儿不良结局无差异。除低血压组基线血压、阻滞平面高度和静脉输液量较高外，基线特征相似。ACE和CYP11B2多态性与低血压之间无显著关联。
AT1R（A1166C）多态性的AC/CC基因型与剖宫产脊髓麻醉下的产妇低血压有关。应检查其与心血管指标和高危产妇的关联。
