连续脊麻对高血压孕妇分娩镇痛时血液动力学的影响：一项对照、随机临床试验。
Effect of continuous spinal anesthesia on the hemodynamics of labor analgesia in hypertensive pregnant women: a comparative, randomized clinical trial.
机构信息
Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital Capital Medical University, Beijing, 100026, China.
出版信息
BMC Anesthesiol. 2023 Jun 13;23(1):205. doi: 10.1186/s12871-023-02174-1.
BACKGROUND
To observe the changes in hemodynamic, stress and inflammatory responses during labor and their labor outcomes after continuous spinal anesthesia labor analgesia for hypertensive pregnant women, and to evaluate whether the continuous spinal anesthesia had any advantages compared to continuous epidural analgesia for hypertensive pregnant women and their newborns.
METHODS
A total of 160 hypertensive pregnant women were selected and randomly divided into continuous spinal anesthesia analgesia group (CSA group) and continuous epidural analgesia group (EA group). Participant age, height, weight and gestational week were recorded; MAP, VAS score, CO and SVR were recorded after the onset of regular uterine contractions (T), 10 min after analgesia (T), 30 min (T), 60 min (T), when the uterine opening was complete (T) and when the fetus was delivered (T); the duration of the first stage of labor and the second stage of labor were recorded; the number of cases of treatment with oxytocin and antihypertensive therapy, mode of delivery, eclampsia and postpartum hemorrhage were counted; pregnant women Bromage scores were recorded at T. We also recorded neonatal weight, Apgar scores at 1, 5 and 10 min after birth; arterial blood gas analysis of the umbilical cord was performed in newborns; finally, TNF-α, IL-6, and cortisol in pregnant women venous blood were measured at T, T, and 24 h after delivery (T). The number of successful compressions and the total drug dosage administered by the analgesic pump were recorded for both groups.
RESULTS
The first stage of labor in CSA was longer than EA (P < 0.05); the MAP, VAS and SVR value in CSA were lower than EA group at T, T and T (P < 0.05); in contrast, the CO in CSA at T3 and T4 was higher than in EA (P < 0.05). The oxytocin was more often used whereas the antihypertensive drugs were less used in CSA as compared to EA. The level of TNF-α, IL-6, Cor in the CSA at T5 was lower than the EA group (P < 0.05), and the level of TNF-α in the CSA group at T7 was lower than the EA group (P < 0.05).
CONCLUSION
For pregnant women with hypertension during pregnancy, continuous spinal anesthesia labor analgesia has no significant effect on the final mode of delivery, but shows precise analgesic effect and stabilizes circulatory system, it is recommended to perform continuous spinal anesthesia early in labor for hypertensive pregnant women, which can effectively reduce the stress reaction.
TRIAL REGISTRATION
ChiCTR-INR-17012659. Date of registration: 13/09/2017.
背景
观察高血压孕妇连续脊髓麻醉分娩镇痛过程中血流动力学、应激和炎症反应的变化及其分娩结局，并评估连续脊髓麻醉相对于连续硬膜外镇痛对高血压孕妇及其新生儿是否具有优势。
方法
选择 160 例高血压孕妇，随机分为连续脊髓麻醉镇痛组（CSA 组）和连续硬膜外镇痛组（EA 组）。记录产妇年龄、身高、体重和孕周；记录规律宫缩开始后（T）、镇痛后 10min（T）、30min（T）、60min（T）、宫口全开时（T）、胎儿娩出时（T）的平均动脉压（MAP）、视觉模拟评分（VAS）、心输出量（CO）和血管阻力（SVR）；记录第一产程和第二产程时间；记录催产素和降压治疗的例数、分娩方式、子痫和产后出血的例数；记录 T 时孕妇的 Bromage 评分；记录新生儿体重、出生后 1、5、10min 的 Apgar 评分；对新生儿进行脐动脉血气分析；最后，分别于 T、T 和分娩后 24h（T）时测量孕妇静脉血中 TNF-α、IL-6 和皮质醇的水平。记录两组镇痛泵的有效按压次数和总药物剂量。
结果
CSA 组第一产程长于 EA 组（P<0.05）；CSA 组在 T、T 和 T 时的 MAP、VAS 和 SVR 值均低于 EA 组（P<0.05）；相反，CSA 组在 T3 和 T4 时的 CO 高于 EA 组（P<0.05）。CSA 组催产素的使用频率高于 EA 组，降压药的使用频率低于 EA 组。CSA 组在 T5 时的 TNF-α、IL-6、Cor 水平低于 EA 组（P<0.05），CSA 组在 T7 时的 TNF-α水平低于 EA 组（P<0.05）。
结论
对于妊娠高血压孕妇，连续脊髓麻醉分娩镇痛对最终分娩方式无明显影响，但具有确切的镇痛效果，可稳定循环系统，建议对高血压孕妇早期行连续脊髓麻醉，可有效降低应激反应。
临床试验注册
ChiCTR-INR-17012659。注册日期：2017 年 9 月 13 日。
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