Zhang Jizheng, Che Jinli, Sun Xiaohua, Li Yi, Ren Wanlu
Gynaecology and Obstetrics Department, Tianjin Hospital Affiliated to Tianjin University, Tianjin, China.
Front Surg. 2025 Jun 18;12:1617342. doi: 10.3389/fsurg.2025.1617342. eCollection 2025.
This study aimed to investigate the impact of maternal type and its interactions on the incidence of hypotension following spinal anesthesia.
In this retrospective cohort study, both primiparous and multiparous women were included. Demographic, pregnancy-related, and hemodynamic data were collected. Univariate and multivariate logistic regression analyses were performed to evaluate the association between these factors and the occurrence of hypotension after spinal anesthesia. Additionally, multivariate models with and without maternal type were constructed, followed by interaction analysis.
Primiparous women had a lower median age and slightly greater weight gain during pregnancy compared to multiparous women. They also exhibited significantly higher pleth variability index (PVI) and heart rate (HR), while heart rate variability (HRV) was significantly lower. Univariate regression analysis identified maternal type, age, weight gain during pregnancy, estimated fetal weight, PVI, HR, HRV, and systolic blood pressure (SBP) as significant predictors of hypotension. Multivariate model analysis showed that adding the variable of parity significantly improved the model's ability to discriminate the occurrence of hypotension (Model 2 AUC = 0.815 vs. Model 1 AUC = 0.740). Interaction analysis revealed significant interactions between heart rate variability (HRV), systolic blood pressure (SBP), gestational weight gain, and parity, suggesting that these physiological characteristics are more strongly associated with hypotension in primiparas.
In conclusion, primiparous women are at significantly higher risk of developing hypotension after spinal anesthesia than multiparous women. Baseline perfusion index (PI), estimated fetal weight, and baseline PVI are key contributing factors to this outcome.
本研究旨在探讨产妇类型及其相互作用对脊麻后低血压发生率的影响。
在这项回顾性队列研究中，纳入了初产妇和经产妇。收集了人口统计学、妊娠相关和血流动力学数据。进行单因素和多因素逻辑回归分析，以评估这些因素与脊麻后低血压发生之间的关联。此外，构建了包含和不包含产妇类型的多因素模型，随后进行交互分析。
与经产妇相比，初产妇的年龄中位数较低，孕期体重增加略多。她们还表现出明显更高的 pleth 变异指数（PVI）和心率（HR），而心率变异性（HRV）则明显较低。单因素回归分析确定产妇类型、年龄、孕期体重增加、估计胎儿体重、PVI、HR、HRV 和收缩压（SBP）是低血压的重要预测因素。多因素模型分析表明，添加产次变量显著提高了模型区分低血压发生的能力（模型 2 AUC = 0.815 对模型 1 AUC = 0.740）。交互分析显示心率变异性（HRV）、收缩压（SBP）、孕期体重增加和产次之间存在显著交互作用，表明这些生理特征与初产妇低血压的相关性更强。
总之，初产妇在脊麻后发生低血压的风险明显高于经产妇。基线灌注指数（PI）、估计胎儿体重和基线 PVI 是导致这一结果的关键因素。
