Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei, Taiwan.
Department of Anesthesiology, Taiwan Adventist Hospital, No. 424, Sec. 2, Bade Rd., Songshan District, Taipei, Taiwan.
Biomed Res Int. 2021 Mar 28;2021:6685584. doi: 10.1155/2021/6685584. eCollection 2021.
Although fixed-volume conventional fluid preloading protocol fails to attenuate postspinal hypotension during cesarean delivery, the effect of goal-directed fluid therapy (GDFT) remains less explored. Continuous noninvasive finger cuff arterial pressure monitoring using devices such as the ClearSight System can provide the noninvasive stroke volume value, enabling clinicians to perform GDFT before spinal anesthesia; however, the efficacy of GDFT requires further elucidation.
In total, 71 consecutive full-term pregnant women were randomly divided into a control group ( = 34) and a GDFT group ( = 37). Before spinal anesthesia, the control group received a fixed dose (1000 mL) of crystalloid fluid, but the GDFT group received repeated 3 mL/kg body weight of crystalloid fluid challenges within 3 minutes with a 1-minute interval between each fluid challenge based on the stroke volume incremental changes obtained using the ClearSight System (targeting a stroke volume increase of ≥5% after a fluid challenge). The primary outcome was the incidence of postspinal hypotension. The secondary outcomes were total fluid volume, vasopressor dosage, hemodynamic parameter changes, maternal adverse effects, and neonatal profiles.
Women in the GDFT group received more fluid than did those in the control group (1132 ± 108 vs. 1247 ± 202 mL; = 0.0044), but the incidence of postspinal hypotension (79.4% vs. 73.0%,; = 0.5864) and norepinephrine dose (12.5 ± 10.6 vs. 15.1 ± 12.8 mcg, respectively; = 0.3512) was comparable between the two groups. Fewer women in the GDFT group experienced nausea (61.76% vs. 35.14%; = 0.0332). Neonatal outcomes (Apgar score and umbilical blood analysis) were comparable and typical in both groups.
ClearSight-guided GDFT did not ameliorate postspinal hypotension but may reduce nausea. This trial is registered with NCT03013140.
虽然传统固定容量的液体预负荷方案不能减轻剖宫产术中脊髓麻醉后的低血压，但目标导向液体治疗（GDFT）的效果仍有待进一步探讨。使用 ClearSight 系统等设备进行连续无创指套动脉血压监测，可以提供无创的每搏输出量值，使临床医生能够在脊髓麻醉前进行 GDFT；然而，GDFT 的疗效仍需要进一步阐明。
总共 71 例足月妊娠妇女连续随机分为对照组（n=34）和 GDFT 组（n=37）。在脊髓麻醉前，对照组接受固定剂量（1000 毫升）晶体液，但 GDFT 组在 3 分钟内根据 ClearSight 系统获得的每搏输出量增量变化重复进行 3 毫升/公斤体重的晶体液冲击，每次冲击之间间隔 1 分钟（目标是在冲击后每搏输出量增加≥5%）。主要结局是脊髓麻醉后低血压的发生率。次要结局包括总液体量、血管加压药剂量、血流动力学参数变化、产妇不良反应和新生儿特征。
GDFT 组的女性接受的液体量多于对照组（1132±108 毫升 vs. 1247±202 毫升；=0.0044），但脊髓麻醉后低血压（79.4% vs. 73.0%；=0.5864）和去甲肾上腺素剂量（12.5±10.6 微克 vs. 15.1±12.8 微克，分别；=0.3512）的发生率相似。GDFT 组恶心的女性较少（61.76% vs. 35.14%；=0.0332）。两组新生儿结局（Apgar 评分和脐血分析）均相似且典型。
ClearSight 指导的 GDFT 不能改善脊髓麻醉后低血压，但可能减少恶心。该试验在 NCT03013140 注册。
