Gkounti Georgia, Loutradis Charalampos, Katsioulis Christos, Nevras Vasileios, Tzimou Myrto, Pitoulias Apostolos G, Argiriadou Helena, Efthimiadis Georgios, Pitoulias Georgios A
Second Department of Surgery- Division of Vascular Surgery, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece.
School of Health Sciences, Faculty of Medicine, Department of Anesthesia and Intensive Care, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Clin Monit Comput. 2025 Feb;39(1):85-93. doi: 10.1007/s10877-024-01220-8. Epub 2024 Sep 21.
Regional anaesthesia techniques provide highly effective alternative to general anaesthesia. Existing evidence on the effect of spinal anaesthesia (SA) on cardiac diastolic function is scarce. This study aimed to evaluate the effects of a single-injection, low-dose SA on left ventricular end-diastolic pressures (LVEDP) using echocardiography in euvolaemic patients undergoing elective vascular surgery.
This is a prospective study in adult patients undergoing elective vascular surgery with SA. Patients with contraindications for SA or significant valvular disease were excluded. During patients' evaluations fluid administration was targeted using arterial waveform monitoring. All patients underwent echocardiographic studies before and after SA for the assessment of indices reflective of diastolic function. LVEDP was evaluated using the E/e' ratio. Blood samples were drawn to measure troponin and brain natriuretic peptide (BNP) levels before and after SA.
A total of 62 patients (88.7% males, 71.00 ± 9.42 years) were included in the analysis. In total population, end-diastolic volume (EDV, 147.51 ± 41.36 vs 141.72 ± 40.13 ml; p = 0.044), end-systolic volume (ESV, 69.50 [51.50] vs 65.00 [29.50] ml; p < 0.001) and E/e' ratio significantly decreased (10.80 [4.21] vs. 9.55 [3.91]; p = 0.019). In patients with elevated compared to those with normal LVEDP, an overall improvement in diastolic function was noted. The A increased (- 6.58 ± 11.12 vs. 6.46 ± 16.10; p < 0.001) and E/A decreased (0.02 ± 0.21 vs. - 0.36 ± 0.90; p = 0.004) only in the elevated LVEDP group. Patients with elevated LVEDP had a greater decrease in E/e' compared to those with normal LVEDP (- 0.03 ± 2.39 vs. - 2.27 ± 2.92; p = 0.002).
This study in euvolaemic patients undergoing elective vascular surgery provides evidence that SA improved LVEDP.
区域麻醉技术为全身麻醉提供了高效的替代方案。关于脊髓麻醉（SA）对心脏舒张功能影响的现有证据很少。本研究旨在使用超声心动图评估单次注射、低剂量SA对接受择期血管手术的血容量正常患者左心室舒张末期压力（LVEDP）的影响。
这是一项对接受SA择期血管手术的成年患者进行的前瞻性研究。排除有SA禁忌症或严重瓣膜疾病的患者。在患者评估期间，使用动脉波形监测来指导液体输注。所有患者在SA前后均接受超声心动图检查，以评估反映舒张功能的指标。使用E/e'比值评估LVEDP。在SA前后采集血样以测量肌钙蛋白和脑钠肽（BNP）水平。
共有62例患者（男性占88.7%，年龄71.00±9.42岁）纳入分析。在总体人群中，舒张末期容积（EDV，147.51±41.36 vs 141.72±40.13 ml；p = 0.044）、收缩末期容积（ESV，69.50[51.50] vs 65.00[29.50] ml；p < 0.001）和E/e'比值显著降低（10.80[4.21] vs. 9.55[3.91]；p = 0.019）。与LVEDP正常的患者相比，LVEDP升高的患者舒张功能总体有所改善。仅在LVEDP升高组中，A增加（-6.58±11.12 vs. 6.46±16.10；p < 0.001）且E/A降低（0.02±0.21 vs. -0.36±0.90；p = 0.004）。与LVEDP正常的患者相比，LVEDP升高的患者E/e'降低幅度更大（-0.03±2.39 vs. -2.27±2.92；p = 0.002）。
这项针对接受择期血管手术的血容量正常患者的研究提供了证据，表明SA可改善LVEDP。
