Division of Obstetric Anesthesia, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, Minami-ku, Sagamihara City, Kanagawa, Japan.
Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
Int J Obstet Anesth. 2023 May;54:103645. doi: 10.1016/j.ijoa.2023.103645. Epub 2023 Feb 28.
We evaluated whether baseline maternal heart rate variability (HRV), including the Analgesia Nociception Index (ANI), is associated with maternal hypotension and fetal heart rate (FHR) abnormalities following combined spinal-epidural (CSE) labor analgesia.
Laboring women were enrolled in this prospective observational study. The primary endpoint was maternal hypotension. The secondary endpoint was FHR abnormalities within 30 min following CSE analgesia initiated with intrathecal plain bupivacaine 1.0 mg and fentanyl 20 µg. The maternal ANI, electrocardiogram, blood pressure, heart rate, oxygen saturation, and FHR tracings were recorded 15 min before and 30 min after CSE. Parturients were grouped based on presence of hypotension and FHR abnormalities. Patient demographics and HRV metrics were compared. Receiver operating characteristics (ROC) curves were constructed for the prediction of hypotension and FHR abnormalities.
No significant intergroup differences were detected in patient characteristics. Several baseline HRV metrics and ANI differed significantly between the normotensive (n = 50) and hypotensive (n = 31) groups and between parturients showing FHR abnormalities (n = 19) and those showing reassuring FHR traces (n = 62). The area under the ROC curve (AUC) for predicting hypotension of the baseline low-frequency (LF)/high-frequency (HF) ratio was 0.677 (95% CI 0.55 to 0.80), and that of the ANI was 0.858 (95% CI 0.78 to 0.94). For predicting non-reassuring FHR patterns, the AUC of the LF/HF ratio was 0.77 (95% CI 0.65 to 0.89), and that of the ANI was 0.833 (95% CI 0.72 to 0.94).
The ANI can predict the propensity for maternal hypotension and non-reassuring FHR patterns following CSE.
我们评估了基线时母体心率变异性（HRV），包括镇痛伤害指数（ANI），是否与椎管内分娩镇痛后母体低血压和胎儿心率（FHR）异常有关。
本前瞻性观察性研究纳入了临产的女性。主要终点为母体低血压。次要终点为椎管内麻醉（CSE）镇痛后 30 分钟内 FHR 异常。CSE 镇痛时鞘内注射 1.0mg 布比卡因和 20μg 芬太尼。在 CSE 前 15 分钟和后 30 分钟记录母体 ANI、心电图、血压、心率、血氧饱和度和 FHR 描记图。根据低血压和 FHR 异常的存在将产妇分组。比较患者的人口统计学特征和 HRV 指标。绘制受试者工作特征（ROC）曲线预测低血压和 FHR 异常。
两组患者的特征无显著差异。在正常血压（n=50）和低血压（n=31）组以及 FHR 异常（n=19）和 FHR 描记图正常（n=62）组之间，多个基线 HRV 指标和 ANI 存在显著差异。基线低频（LF）/高频（HF）比值预测低血压的 ROC 曲线下面积（AUC）为 0.677（95% CI 0.55 至 0.80），ANI 的 AUC 为 0.858（95% CI 0.78 至 0.94）。预测非典型 FHR 模式时，LF/HF 比值的 AUC 为 0.77（95% CI 0.65 至 0.89），ANI 的 AUC 为 0.833（95% CI 0.72 至 0.94）。
ANI 可预测 CSE 后母体低血压和非典型 FHR 模式的倾向。
