Md Nizar Nur Dyana, Hassan Shamsul Kamalrujan, Mohamad Zaini Rhendra Hardy, Hassan Mohamad Hasyizan, Wan Hassan Wan Mohd Nazaruddin, Mazlan Mohd Zulfakar
Department of Anaesthesiology & Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
Department of Anaesthesiology & Intensive Care, Hospital Universiti Sains Malaysia, Kelantan, Malaysia.
Malays J Med Sci. 2020 Dec;27(6):68-78. doi: 10.21315/mjms2020.27.6.7. Epub 2020 Dec 29.
Hypotension is a common complication following spinal anaesthesia. The administration of intravenous fluids prior to spinal anaesthesia, known as pre-loading, has been used to offset the hypotension effect; however, the ideal fluid for pre-loading is still a matter of debate. The objective of this study was to compare the effects of Gelaspan 4% and Volulyte 6% as pre-loading fluids.
A total of 93 patients with American Society of Anaesthesiologists (ASA) physical status I or II having lower limb orthopaedic surgery under spinal anaesthesia were randomised into two groups that received either Volulyte ( 47) or Gelaspan ( 46). Before the spinal anaesthesia, these patients were pre-loaded with 500 mL of the fluid of their respective group. Blood samples were taken before pre-loading and again after spinal anaesthesia and sent for venous blood gas and electrolyte level measurement. Baseline and intraoperative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and the requirement of ephedrine to treat hypotension were also recorded.
Both fluids could not prevent significant reductions in SBP ( 0.011), DBP ( 0.002) and MAP ( 0.001). There was also significant reduction in HR over time ( 0.001). There was no significant difference in terms of ephedrine usage between both groups. Neither Volulyte 6% nor Gelaspan 4% caused significant changes in acid-base status.
The use of 500 mL of either Gelaspan 4% or Volulyte 6% as pre-loading fluids did not significantly prevent the incidence of post-spinal anaesthesia hypotension following orthopaedic lower limb surgery; however, both were useful in the maintenance normal acid-base balance.
低血压是脊髓麻醉后的常见并发症。在脊髓麻醉前静脉输注液体（即预负荷）已被用于抵消低血压效应；然而，理想的预负荷液体仍是一个有争议的问题。本研究的目的是比较4% 明胶溶液和6% 聚明胶肽作为预负荷液体的效果。
总共93例美国麻醉医师协会（ASA）身体状况为I或II级、接受脊髓麻醉下下肢骨科手术的患者被随机分为两组，分别接受聚明胶肽（47例）或明胶溶液（46例）。在脊髓麻醉前，这些患者接受500 mL各自分组的液体进行预负荷。在预负荷前和脊髓麻醉后再次采集血样，送去检测静脉血气和电解质水平。还记录了收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）的基线和术中记录以及治疗低血压所需麻黄碱的用量。
两种液体均不能显著预防SBP（P = 0.011）、DBP（P = 0.002）和MAP（P = 0.001）的显著降低。随着时间推移HR也有显著降低（P = 0.001）。两组之间在麻黄碱使用方面无显著差异。6% 聚明胶肽和4% 明胶溶液均未引起酸碱状态的显著变化。
使用500 mL 4% 明胶溶液或6% 聚明胶肽作为预负荷液体并不能显著预防下肢骨科手术后脊髓麻醉后低血压的发生；然而，两者都有助于维持正常的酸碱平衡。
