Robson S C, Samsoon G, Boys R J, Rodeck C, Morgan B
Institute of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Chiswick, London.
Br J Anaesth. 1993 Jun;70(6):634-8. doi: 10.1093/bja/70.6.634.
We have performed serial haemodynamic investigations in 20 women undergoing elective Caesarean section under continuous spinal anaesthesia with a 32-gauge catheter with 0.5% heavy bupivacaine. Cardiac output was measured by Doppler and cross-sectional echocardiography at the aortic valve. Doppler flow velocity waveforms were recorded also from the umbilical artery. A block to T4 or above was achieved in all patients. The median dose of 0.5% bupivacaine administered was 2.0 ml (range 1.5-4.5 ml). Mean cardiac output increased from 7 to 8 litre min-1 after preloading with Ringer lactate solution 1.5 litre and then remained unchanged after injection of bupivacaine. Two subjects developed hypotension, although mean values of arterial pressure and umbilical artery pulsatility index did not change. The median umbilical artery pH was 7.27 (range 6.98-7.32) and there was a significant correlation between pH and the maximum percentage decrease in cardiac output. The results suggest that continuous spinal anaesthesia is associated with greater haemodynamic stability than single bolus spinal injection.
我们对20例行择期剖宫产术的女性进行了系列血流动力学研究，这些女性在连续蛛网膜下腔麻醉下使用32G导管和0.5%重比重布比卡因。通过多普勒和主动脉瓣处的横截面超声心动图测量心输出量。还记录了脐动脉的多普勒血流速度波形。所有患者均达到T4及以上平面的阻滞。给予的0.5%布比卡因的中位剂量为2.0 ml（范围1.5 - 4.5 ml）。在预充1.5升乳酸林格溶液后，平均心输出量从7升/分钟增加到8升/分钟，然后在注射布比卡因后保持不变。两名受试者出现低血压，尽管动脉压和脐动脉搏动指数的平均值没有变化。脐动脉pH的中位数为7.27（范围6.98 - 7.32），并且pH与心输出量的最大百分比下降之间存在显著相关性。结果表明，与单次蛛网膜下腔推注相比，连续蛛网膜下腔麻醉具有更高的血流动力学稳定性。
