Anesthesiology and Reanimation Department, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey.
Gynecology and Obstetrics Department, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey.
Arch Gynecol Obstet. 2024 Jun;309(6):2633-2641. doi: 10.1007/s00404-023-07166-7. Epub 2023 Aug 5.
There are limited studies focusing on hemodynamic changes between elective and emergent C/S cases. We considered that a better understanding of the alterations and physiological reactions in both situations with non-invasive novel technologies might be useful in managing maternal and fetal sides.
In this prospective observational study, non-invasive hemodynamic changes were observed by using the whole-body impedance method using the NICaS™ device. CO, cardiac index (CI), stroke volume (SV), stroke index (SI), total peripheric resistance (TPR), and cardiac reserve (GGI) parameters were evaluated with a non-invasive method. Measurements were done initiating before surgery, 9 times of 5 min intervals.
All 95 patients finished the study. 47 cesarean sections were in the elective group, 48 were in the emergent group. SV in 4.5.6. time intervals were statistically increased in the elective group (p values: SvMl4: 0.025, SvMl5: 0.049, SvMl6: 0.044) (p < 0.05). SI in the second-time interval was statistically increased in the emergent group (p-value SI2: 0.047) (p < 0.05). SI in the 4th time interval was statistically increased in the elective group (p-value SI4: 0.047) (p < 0.05). CO measurements were not statistically different between groups in all time intervals for all comparisons. CI in the second time interval was statistically decreased in the elective group (p-value CI2: 0.012) (p < 0.05). GGI in the 4th time interval was statistically increased in the elective group (p-value GGI4: 0.035) (p < 0.05). TPRI in the second time interval was statistically increased in the elective group (p-value TPRI 2: 0.014) (p < 0.05).
Understanding normal hemodynamic values before, during, and after C/S is feasible and might help the clinician assess patients' cardiac performance with a reliable noninvasive technique. NICaS might be a reliable tool to evaluate patients' baseline values and diagnose complications earlier during the surgery.
目前针对择期与紧急剖宫产术产妇的血液动力学变化的研究十分有限。我们认为，利用非侵入性新技术更好地了解这两种情况下的变化和生理反应，可能有助于管理产妇和胎儿。
本前瞻性观察研究使用 NICaS 设备通过全身阻抗法观察非侵入性血液动力学变化。使用非侵入性方法评估心输出量 (CO)、心指数 (CI)、每搏输出量 (SV)、每搏指数 (SI)、总外周阻力 (TPR) 和心脏储备 (GGI) 参数。测量在术前开始，每 5 分钟进行 9 次测量。
所有 95 例患者均完成了研究。47 例剖宫产术为择期组，48 例为急诊组。择期组 SV 在第 4.5.6 个时间间隔的测量值明显增加（p 值：SVml4：0.025，SVml5：0.049，SVml6：0.044）（p<0.05）。急诊组 SI 在第 2 个时间间隔的测量值明显增加（p 值 SI2：0.047）（p<0.05）。SI 在第 4 个时间间隔的测量值在择期组中明显增加（p 值 SI4：0.047）（p<0.05）。CO 测量值在所有时间间隔的组间比较均无统计学差异。CI 在第 2 个时间间隔的测量值在择期组中明显下降（p 值 CI2：0.012）（p<0.05）。在第 4 个时间间隔的测量值在择期组中明显增加（p 值 GGI4：0.035）（p<0.05）。在第 2 个时间间隔的测量值 TPRI 在择期组中明显增加（p 值 TPRI2：0.014）（p<0.05）。
了解剖宫产术前、术中和术后的正常血液动力学值是可行的，并且可能有助于临床医生使用可靠的非侵入性技术评估患者的心脏功能。NICaS 可能是一种可靠的工具，可用于评估患者的基线值，并在手术过程中更早地诊断并发症。
