Aslanlar Emine, Alharach Camille Kamel, Kara İnci, Onal Ozkan, Aslanlar Durmuş Ali
Department of Anesthesiology, Medicine Faculty, Selcuk University, Ardıçlı, Akademi, Celal Bayar St. No. 313, Konya 42250, Turkey.
Department of Anesthesiology, Medicine Faculty, Başkent University, Hocacihan Mahallesi Saray Caddesi No. 1, Konya 42080, Turkey.
J Clin Med. 2023 Dec 23;13(1):85. doi: 10.3390/jcm13010085.
Early diagnosis and treatment of postspinal hypotension (PSH) in obstetric anaesthesia reduces the risk of maternofetal complications. In this study, the effect of EtCO and the integrated pulmonary index (IPI) in predicting PSH was investigated. Patients scheduled for cesarean section under spinal anaesthesia were included. The Capnostream 35 respiratory monitor (Medtronic, Inc., Dublin, Ireland) was used for EtCO and IPI. PSH developed in 52 (63.4%) of the 82 patients. EtCO and IPI values decreased significantly compared with baseline values in patients who developed PSH. There were statistically significant differences in EtCO ( = 0.001) and the IPI change ( = 0.045) in patients who developed PSH compared with those who did not. It was found that the EtCO difference had an independent effect on predicting PSH ( < 0.05), whereas the IPI difference did not ( > 0.05). One unit decrease in EtCO from the baseline increased the risk of PSH by 3.3 times. ROC curve analysis showed that the magnitude of change in EtCO was diagnostic for predicting PSH (AUC: 0.90 (0.83-0.97; < 0.001)). IPI showed no predictive value for postspinal hypotension in cesarean section. However, EtCO monitoring, which is non-invasive and real-time monitoring, can be used to predict postspinal hypotension.
产科麻醉中脊髓麻醉后低血压（PSH）的早期诊断和治疗可降低母婴并发症的风险。在本研究中，调查了呼气末二氧化碳分压（EtCO）和综合肺指数（IPI）对预测PSH的作用。纳入计划在脊髓麻醉下进行剖宫产的患者。使用Capnostream 35呼吸监测仪（美敦力公司，爱尔兰都柏林）测量EtCO和IPI。82例患者中有52例（63.4%）发生了PSH。发生PSH的患者EtCO和IPI值与基线值相比显著降低。发生PSH的患者与未发生PSH的患者相比，EtCO（P = 0.001）和IPI变化（P = 0.045）存在统计学显著差异。发现EtCO差值对预测PSH有独立作用（P < 0.05），而IPI差值则无（P > 0.05）。EtCO较基线值每降低1个单位，PSH风险增加3.3倍。ROC曲线分析表明，EtCO的变化幅度对预测PSH具有诊断价值（AUC：0.90（0.83 - 0.97；P < 0.001））。IPI对剖宫产脊髓麻醉后低血压无预测价值。然而，EtCO监测为无创实时监测，可用于预测脊髓麻醉后低血压。
