Elsakka Ahmed Ibrahim, Mostafa Gamal, Mohamed Mohamed Raafat Abdelaziz, Mahrous Reham, Abdelnasser Amr
Department of Anesthesia, Surgical ICU and Pain Management, Cairo University, Egypt.
Indian J Anaesth. 2024 Feb;68(2):153-158. doi: 10.4103/ija.ija_695_23. Epub 2024 Jan 29.
Maternal hypotension is a common and dangerous consequence after a subarachnoid block for a caesarean section. Combining pharmacological methods such as norepinephrine infusion, ondansetron and non-pharmacological methods in delayed supine positioning better impacts the maternal haemodynamic profile. The present study assessed the benefits and adverse effects of combining pharmacological and non-pharmacological methods in hypotension prophylaxis.
This randomised controlled trial was conducted at Cairo University Hospital's obstetric theatre from January to October 2020. The study included 85 parturients who were randomised to two groups. Group Sitting was left seated for 2 min after injection, and Group Control was made to lie down in the supine position immediately after the subarachnoid block. Both groups received prophylactic intravenous norepinephrine infusion, in addition to an ondansetron bolus, before surgery. Patients' systolic blood pressure (SBP) from intrathecal injection until delivery of the foetus, was documented.
The Sitting group's SBP (122 (14) mmHg) till delivery was statistically higher than the Control group's readings (114 (10) mmHg) ( = 0.004). The Sitting group's intraoperative SBP values were often greater than the Control group values. In addition, the Sitting group had a reduced hypotension incidence and a lower rate of ephedrine use than the other group, but bradycardia incidence was comparable between both groups.
In elective caesarean delivery, combining pharmacological and non-pharmacological methods achieve better results regarding maternal hypotension, vasopressor consumption, nausea and vomiting, and foetal outcomes.
蛛网膜下腔阻滞用于剖宫产术后，产妇低血压是常见且危险的后果。将诸如去甲肾上腺素输注、昂丹司琼等药理学方法与延迟仰卧位的非药理学方法相结合，对产妇血流动力学状况有更好的影响。本研究评估了药理学和非药理学方法联合用于预防低血压的益处和不良反应。
本随机对照试验于2020年1月至10月在开罗大学医院产科手术室进行。该研究纳入85名产妇，随机分为两组。坐立组在注射后保持坐姿2分钟，对照组在蛛网膜下腔阻滞后立即仰卧。两组在手术前均接受预防性静脉输注去甲肾上腺素，此外还给予一剂昂丹司琼。记录患者从鞘内注射至胎儿娩出时的收缩压（SBP）。
直至分娩时，坐立组的SBP（122（14）mmHg）在统计学上高于对照组的读数（114（10）mmHg）（P = 0.004）。坐立组术中SBP值通常高于对照组。此外，坐立组低血压发生率和麻黄碱使用率低于另一组，但两组心动过缓发生率相当。
在择期剖宫产中，药理学和非药理学方法联合应用在产妇低血压、血管升压药使用、恶心呕吐及胎儿结局方面取得更好的效果。
