Van Bogaert L J
Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Transkei, E. Cape, South Africa.
East Afr Med J. 1998 Apr;75(4):227-31.
The objective of this work was to determine whether parturients with pregnancy-induced hypertension (PIH) are at higher risk of post-spinal hypotension at caesarean section. This was an observational study of 24 women with PIH undergoing caesarean section under spinal analgesia with 0.5% hyperbaric bupivacaine, compared with 24 matched normotensive parturients receiving a spinal block for caesarean section. The mean intra-operative systolic arterial pressure (SAP) was similar with and without PIH (p = 0.38). The mean percentage decrease in SAP of baseline was more with PIH (16.2%) than in the controls (0.5%) (p < 0.001). The number of episodes of severe hypotension (SAP decrease to < or = 80% of baseline and < 90 mmHg) (p = 0.80) as well as the magnitude (p = 0.31) of severe hypotension was similar in both groups. There was no difference in the evolution of diastolic arterial pressure and maternal pulse rate between cases and controls. Maximum levels of upper sensory blockade were similar. Foetal and maternal outcome was similar with and without PIH. The decrease in SAP is less on an absolute scale but more on a percentile basis with PIH at caesarean section under spinal analgesia than in normotensive patients. The difference, however, is not clinically sufficient to discourage spinal analgesia for caesarean section with a low dose (1.5 ml, 7.5 mg) of 0.5% hyperbaric bupivacaine in parturients with PIH.
这项研究的目的是确定妊娠高血压综合征（PIH）产妇在剖宫产时发生脊髓麻醉后低血压的风险是否更高。这是一项观察性研究，对24例接受0.5%重比重布比卡因脊髓镇痛下行剖宫产的PIH产妇，与24例匹配的接受剖宫产脊髓阻滞的血压正常产妇进行比较。有无PIH时术中平均收缩动脉压（SAP）相似（p = 0.38）。PIH组SAP较基线的平均下降百分比（16.2%）高于对照组（0.5%）（p < 0.001）。两组严重低血压发作次数（SAP降至基线的≤80%且<90 mmHg）（p = 0.80）以及严重低血压的程度（p = 0.31）相似。病例组和对照组之间舒张压和产妇脉搏率的变化无差异。感觉阻滞最高平面相似。有无PIH时胎儿和产妇结局相似。在脊髓镇痛下行剖宫产时，与血压正常患者相比，PIH产妇SAP的绝对下降幅度较小，但百分比下降幅度较大。然而，这种差异在临床上并不足以阻止对PIH产妇使用低剂量（1.5 ml，7.5 mg）0.5%重比重布比卡因进行剖宫产脊髓镇痛。
