Zhang Xiaoyu, Xu Tao, Jia Lijie, Cao Huimin, Xu Zifeng
Department of Anesthesiology, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
Ann Palliat Med. 2021 Jul;10(7):7184-7193. doi: 10.21037/apm-21-598. Epub 2021 Jun 11.
Pressure recording analytical method (PRAM) of MOSTCARE is a minimally invasive system based on mathematical analysis of arterial pressure profile changes and allows continuous recording of hemodynamic measurements. Herein, we aimed to use the MostCare system to investigate the hemodynamics of patients receiving spinal anesthesia during elective cesarean section.
In this observational study, we recruited 17 patients scheduled for elective cesarean section. For each patient, we acquired continuous recordings of hemodynamic parameters at 14 key timepoints: surgical admission (two baseline parameters), immediately after the administration of spinal anesthesia, six subsequent time points (2, 4, 6, 8, 10, and 12 min after anesthesia), during peritoneum and uterine incision, during delivery, following the administration of oxytocin, and after surgery had been completed. Statistical analysis was carried out by repeated measures analysis of variance (ANOVA).
During a twelve min period after spinal anesthesia, we observed significant reductions in mean arterial pressure (MAP), dicrotic pressure (Pdic), cardiac index (CI), stroke volume index (SVI), dP/dtmax, and cardiac cycle efficiency (CCE) (P<0.05 for all). However, systemic vascular resistance index (SVRI) was reversely correlated to CI and increased significantly after spinal anesthesia (P<0.05). These hemodynamic parameters return to near basal values after peritoneum incision. Furthermore, there were significant fluctuations in MAP, Pdic and CI after oxytocin administration (P<0.05).
PRAM of MostCare system revealed significant changes in key hemodynamic parameters undergoing cesarean section with spinal anesthesia. It enables clinicians gain a much better understanding of hemodynamics of parturients and optimize clinical management strategies.
This study was registered at http://www.chictr.org.cn on 16, July, 2019. No. ChiCTR1900024566.
MOSTCARE的压力记录分析方法（PRAM）是一种基于动脉压力曲线变化数学分析的微创系统，可连续记录血流动力学测量值。在此，我们旨在使用MostCare系统研究择期剖宫产术中接受脊髓麻醉患者的血流动力学。
在这项观察性研究中，我们招募了17例计划进行择期剖宫产的患者。对于每位患者，我们在14个关键时间点连续记录血流动力学参数：手术入院时（两个基线参数）、脊髓麻醉给药后立即记录、随后六个时间点（麻醉后2、4、6、8、10和12分钟）、腹膜和子宫切开时、分娩期间、催产素给药后以及手术完成后。采用重复测量方差分析（ANOVA）进行统计分析。
在脊髓麻醉后的12分钟内，我们观察到平均动脉压（MAP）、舒张压（Pdic）、心脏指数（CI）、每搏量指数（SVI）、dP/dtmax和心动周期效率（CCE）均显著降低（所有P<0.05）。然而，全身血管阻力指数（SVRI）与CI呈负相关，脊髓麻醉后显著升高（P<0.05）。这些血流动力学参数在腹膜切开后恢复到接近基础值。此外，催产素给药后MAP、Pdic和CI有显著波动（P<0.05）。
MostCare系统的PRAM显示，脊髓麻醉下行剖宫产术时关键血流动力学参数有显著变化。它使临床医生能够更好地了解产妇的血流动力学，并优化临床管理策略。
本研究于2019年7月16日在http://www.chictr.org.cn注册。注册号：ChiCTR1900024566。
