Ghisi Daniela, Garroni Marco, Giannone Sandra, De Grandis Giovanni, Fanelli Andrea, Sorella Maria Cristina, Bonarelli Stefano, Melotti Rita Maria
Department of Anesthesia and Psotoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna.
b. Anesthesia and Intensive Care, Ospedale Santa Maria delle Croci, viale Randi 5, 48121 Ravenna, Italy.
Acta Biomed. 2020 Nov 10;91(4):e2020182. doi: 10.23750/abm.v91i4.8665.
Patients undergoing elective primary total hip replacement and spinal anesthesia may encounter significant hemodynamic instability Objective: The study is aimed at observing the haemodynamic modifications after spinal anaesthesia during total hip replacement in patients managed to "preload independence" with goal directed fluid therapy (GDFT) and monitored non-invasively with Clearsight.
Thirty patients, aged 50-80 years, with an American Society of Anaesthesiologists' (ASA) score II-III, undergoing elective primary total hip replacement and spinal anaesthesia were enrolled. Patients were monitored with the EV1000 platform and the Clearsight finger-cuff and managed with a goal directed fluid therapy.
The 79% of the population showed preload independence at baseline. After spinal, the 93% did not show a significant mean arterial pressure reduction. In our population, 79% reported a decrease >10% of the stroke volume during surgery, while 66% in the Recovery Room. Patients showed an improvement in mean arterial pressure, systemic vascular resistances indexed (SVRI), stroke volume (SV) and stroke volume indexed (SVI) at spinal resolution compared to baseline.
Our cohort population showed hemodynamic stability throughout the study period, with increased SV and decreased SVRI at spinal resolution compared to basal values. Further randomized prospective studies are advocated in the same setting.
接受择期初次全髋关节置换术并采用脊髓麻醉的患者可能会出现显著的血流动力学不稳定。目的：本研究旨在观察在目标导向液体治疗（GDFT）实现“预负荷独立”并使用Clearsight进行无创监测的患者全髋关节置换术中脊髓麻醉后的血流动力学变化。
纳入30例年龄在50 - 80岁、美国麻醉医师协会（ASA）评分II - III级、接受择期初次全髋关节置换术并采用脊髓麻醉的患者。使用EV1000平台和Clearsight指套对患者进行监测，并采用目标导向液体治疗。
79%的患者在基线时表现为预负荷独立。脊髓麻醉后，93%的患者平均动脉压未出现显著降低。在我们的研究人群中，79%的患者在手术期间心搏量减少>10%，而在恢复室中这一比例为66%。与基线相比，患者在脊髓麻醉消退时平均动脉压、全身血管阻力指数（SVRI）、心搏量（SV）和心搏量指数（SVI）均有所改善。
我们的队列人群在整个研究期间表现出血流动力学稳定性，与基础值相比，脊髓麻醉消退时SV增加，SVRI降低。提倡在相同背景下进行进一步的随机前瞻性研究。
