静脉葡萄糖酸钙对剖宫产脊麻后低血压预防作用的随机双盲对照研究。

Effect of Intravenous Calcium Gluconate on Prevention of Post Spinal Hypotension during Spinal Anaesthesia for Caesarean Section: A Randomized Double-Blind Controlled Study.

机构信息

UCMS and associated GTB Hospital, Shahdara, Delhi, India.

Department of Anaesthesiology, Pain and critical care, AIIMS, Delhi, India. New Delhi, India.

出版信息

J Nepal Health Res Counc. 2022 Jun 2;20(1):89-95. doi: 10.33314/jnhrc.v20i01.3882.

DOI:10.33314/jnhrc.v20i01.3882

PMID:35945859

Abstract

BACKGROUND

Calcium, a physiological ion, causes vasoconstriction and has a positive ionotropic action on heart. Its use to prevent post-spinal hypotension has been suggested but never formally evaluated for patients undergoing caesarean section. This study investigated the hemodynamic effects of calcium administration in parturients with the primary aim of comparing the incidence of post-spinal hypotension.

METHODS

Sixty healthy full-term pregnant patients scheduled for caesarean section were randomly allocated to two equal groups to receive either calcium gluconate or normal Saline bolus over 20min by syringe infusion pump under electrocardiography monitoring immediately after the patient was turned supine following spinal anaesthesia. Blood pressure and heart rate were recorded at baseline, and at regular intervals following spinal. Maternal calcium levels were estimated before and after infusion. Neonatal blood gas analysis and calcium level were analyzed. Total mephentermine requirement was recorded in both groups.

RESULTS

The heart rate values remained comparable to baseline value in group calcium gluconate while in group normal Saline, it decreased significantly at 8,12 and 16min. Blood pressure decreased significantly as compared to the baseline value from 4min onwards in both the groups. However, it was comparable in the two groups at all time points(0.622). Nineteen patients(63.33%) required mephentermine infusion in group calcium gluconate as compared to 23 patients(76.6%) in group normal Saline for maintenance of systolic blood pressure.(p=0.791) Umbilical venous pH (p=0.038) and partial pressure of carbon dioxide(p=0.038) were significantly better in group calcium gluconate.

CONCLUSIONS

Calcium used for prophylaxis of hypotension in healthy parturients undergoing caesarean section reduced the vasopressor requirements and total mephenteramine dose, but the difference did not attain statistical significance.

摘要

背景

钙是一种生理离子，可引起血管收缩，并对心脏具有正离子变力作用。有人建议将其用于预防脊髓后低血压，但从未对此类行剖宫产术的患者进行过正式评估。本研究调查了钙给药对产妇血流动力学的影响，主要目的是比较脊髓后低血压的发生率。

方法

60 例健康足月妊娠患者拟行剖宫产术，随机分为两组，每组 30 例，在脊髓麻醉后患者转为仰卧位后 20 分钟内，通过注射泵以葡萄糖酸钙或生理盐水进行推注。在基线时和脊髓后定期记录血压和心率。在输注前后评估母体钙水平。分析新生儿血气分析和钙水平。记录两组的总苯丙醇胺需求量。

结果

葡萄糖酸钙组的心率值与基线值保持可比，而生理盐水组在 8、12 和 16 分钟时显著下降。两组血压均从 4 分钟起与基线值相比显著下降。然而，两组在所有时间点的血压值均相当（0.622）。葡萄糖酸钙组有 19 例（63.33%）需要输注苯丙醇胺，而生理盐水组有 23 例（76.6%）需要维持收缩压（p=0.791）。葡萄糖酸钙组脐静脉 pH（p=0.038）和二氧化碳分压（p=0.038）显著更好。