身高对剖宫产产妇椎管内麻醉扩散及应激反应的影响：一项前瞻性观察研究。
The impact of height on the spread of spinal anesthesia and stress response in parturients undergoing caesarean section: a prospective observational study.
机构信息
Department of Anesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Tianhe district, Guangzhou, 510623, China.
出版信息
BMC Anesthesiol. 2021 Nov 30;21(1):298. doi: 10.1186/s12871-021-01523-2.
BACKGROUND
The spread of spinal anesthesia was influenced by many factors, and the effect of body height on spinal anesthesia is still arguable. This study aimed to explore the impact of height on the spread of spinal anesthesia and the stress response in parturients.
METHODS
A total of ninety-seven parturients were allocated into two groups according to their height: the shorter group (body height was shorter than 158 cm) and taller group (body height was taller than 165 cm). Spinal anesthesia was performed with the same amount of 12 mg plain ropivacaine in mothers of different heights. The primary outcome of the study was the success or failure of the spinal anesthesia. The secondary outcomes of the study were stress response, time to T6 sensory level, the incidence of hypotension, the satisfaction of abdominal muscle relaxation and patient VAS scores.
RESULTS
The rate of successful spinal anesthesia in the shorter group was significantly higher than that in the taller group (p = 0.02). The increase of maternal cortisol level in the shorter group was lower than that in the taller group at skin closure (p = 0.001). The incidence of hypotension (p = 0.013), time to T6 sensory block (p = 0.005), the quality of abdominal muscle relaxation (p < 0.001), and VAS values in stretching abdominal muscles and uterine exteriorization (p < 0.001) in the shorter group were significantly different from those in the taller group. Multivariate analysis showed that vertebral column length (p < 0.001), abdominal girth (p = 0.022), amniotic fluid index (p = 0.022) were significantly associated with successful spinal anesthesia.
CONCLUSIONS
It's difficult to use a single factor to predict the spread of spinal anesthesia. Patient's vertebral column length, amniotic fluid index and abdominal girth were the high determinant factors for predicting the spread of spinal anesthesia.
TRIALS REGISTRATION
ChiCTR-ROC-17012030 ( Chictr.org.cn ), registered on 18/07/2017.
背景
椎管内麻醉的扩散受多种因素影响，身高对椎管内麻醉的影响仍存在争议。本研究旨在探讨身高对产妇椎管内麻醉扩散和应激反应的影响。
方法
根据身高将 97 例产妇分为两组：矮组（身高低于 158cm）和高组（身高高于 165cm）。不同身高的母亲均采用相同剂量的 12mg 布比卡因进行椎管内麻醉。本研究的主要结局是椎管内麻醉的成功或失败。次要结局为应激反应、T6 感觉水平达到时间、低血压发生率、腹肌松弛满意度和患者 VAS 评分。
结果
矮组椎管内麻醉成功率明显高于高组（p=0.02）。皮肤缝合时，矮组产妇皮质醇水平升高低于高组（p=0.001）。矮组低血压发生率（p=0.013）、T6 感觉阻滞时间（p=0.005）、腹肌松弛质量（p<0.001）和牵拉腹肌及子宫外展时 VAS 值（p<0.001）均明显低于高组。多因素分析显示，脊柱长度（p<0.001）、腹围（p=0.022）、羊水指数（p=0.022）与椎管内麻醉成功显著相关。
结论
单一因素难以预测椎管内麻醉的扩散。患者的脊柱长度、羊水指数和腹围是预测椎管内麻醉扩散的高决定因素。
试验注册
ChiCTR-ROC-17012030（Chictr.org.cn），于 2017 年 7 月 18 日注册。
Zotero 插件