子宫左倾位对产妇血流动力学的影响：随机对照研究
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Alcohol Abstinence in Drinkers with Atrial Fibrillation
背景与目的
本研究旨在评估子宫左倾位(LUD)对剖宫产术中蛛网膜下腔阻滞(SAB)产妇血流动力学的影响。主要评估指标是产前LUD组和非LUD组之间的心输出量(CO)差异。
方 法
60例拟于SAB下行择期剖宫产(CD)的足月妊娠健康产妇被随机分为2组，LUD组和非LUD组。使用无创CO监测器Nexfin测量血流动力学特征。所有患者术前输注晶体液扩容(10ml/kg)，并用麻黄碱纠正低血压。SAB前至手术结束后，连续监测患者的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、心输出量（CO）、全身血管阻力（SVR）、左室等容收缩指数（dP/dT）。
结 果
SAB后至胎儿娩出前5min，LUD组CO(7.20 ±1.78L/min[95%CI 6.53~7.87] vs. 6.23±1.44 L/min [95% CI 5.69~6.77]; p = 0.016) 和dP/dT (784±313mmHg/s vs. 604 ± 241 mmHg/s; p = 0.020) 明显高于非LUD组。SAB后5min，LUD组产妇收缩压下降的发生率较低(16.7% vs. 53.3%, p = 0.003) 。
结 论
本研究表明，胎儿娩出前保持LUD可使产妇血流动力学变化更为平稳（较高的CO和dP/dT、较少的低血压发生率）。
原始文献来源及摘要
Chungsamarnyart Y, Wacharasint P, Carvalho B.Hemodynamic profiles with and without left uterine displacement: A randomized study in term pregnancies receiving subarachnoid blockade for cesarean delivery.J Clin Anesth.2020,64:123–130.
Abstract
Study objective: The aim of this study was to evaluate the effect of left uterine displacement (LUD) on maternal hemodynamic measures following subarachnoid blockade (SAB) for cesarean delivery (CD). The primary outcome was cardiac output (CO) differences between the LUD and non-LUD groups pre-delivery.
Design: Prospective, randomized, controlled study.
Setting: Obstetric operating room.
Materials and methods: We studied hemodynamic profiles in sixty healthy women with term pregnancies who underwent elective CD with SAB. Hemodynamics were measured using a non-invasive CO monitor, the Nexfin™. All women received a crystalloid 10 mL/kg preload, and hypotension was treated with ephedrine boluses.
Interventions: Sixty women with term pregnancies were randomized into two groups: LUD group (received 15–30° LUD after SAB, n = 30) and non-LUD group (no LUD after SAB, n = 30).
Measurements: Patient's hemodynamic variables including systolic blood pressure (SBP), diastolic blood pressure(DBP), mean arterial pressure (MAP), heart rate (HR), CO, systemic vascular resistance (SVR), and left ventricular contractility index (dP/dT) were measured continuously from pre-SAB until end of surgery.
Main results: In pre-delivery phase at 5 min after spinal anesthesia, the LUD group had significantly higher CO(7.20 ± 1.78 [95%CI 6.53–7.87] vs. 6.23 ± 1.44 L/min [95% CI 5.69–6.77]; p = 0.016) and higher dP/dT(784 ± 313 vs. 604 ± 241 mmHg/s; p = 0.020) than the non-LUD group. The LUD group had a lower incidence of maternal systolic hypotension at 5-min post-SAB (16.7% vs. 53.3% in non-LUD group, p = 0.003).
Conclusions: The study demonstrates modest hemodynamic advantages (higher CO, less hypotension, higher dP/dT) with pre-delivery LUD. The results support maternal hemodynamic benefits of LUD until delivery in women with term pregnancies undergoing CD with SAB.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：唐剑 编辑：冯玉蓉 审校：曹莹