PDF(Pubmed)
Abstract：
BACKGROUND: Current guidelines recommend prophylactic vasopressor administration during spinal anesthesia for cesarean delivery to maintain intraoperative blood pressure above 90% of the baseline value. We sought to determine the optimum baseline mean arterial pressure (MAP) reading to guide the management of spinal hypotension.
METHODS: We performed a secondary analysis of data collected from normotensive patients presenting for elective cesarean delivery in a tertiary care institution from October 2018 to August 2020. We compared the magnitude of hypotension in patients who reported nausea versus those who did not, using a case-control design. Baseline MAPs at last office visit, morning of surgery, or operating room (pre-spinal) were determined. We calculated the duration and degree of hypotension using the area under the curve (AUC) when the MAP of the respective patient was below 90% of each baseline.
RESULTS: The patients who experienced nausea (n=45) had longer and more profound periods of hypotension than those who did not develop nausea (n=240). A comparison of AUC using MAP baseline at the last office visit or on the morning of surgery showed a statistically significant between-group difference, P=0.02, and P=0.005, respectively, and no significant between-group difference when 90% of the MAP baseline in the operating room was used.
CONCLUSIONS: Patients had the highest preoperative MAP in the operating room and the AUC was similar for those with and without nausea when the pre-spinal MAP baseline was used. Therefore, maintaining higher intraoperative blood pressure using individual pre-spinal MAP as baseline should reduce intraoperative maternal nausea.
METHODS: We performed a secondary analysis of data collected from normotensive patients presenting for elective cesarean delivery in a tertiary care institution from October 2018 to August 2020. We compared the magnitude of hypotension in patients who reported nausea versus those who did not, using a case-control design. Baseline MAPs at last office visit, morning of surgery, or operating room (pre-spinal) were determined. We calculated the duration and degree of hypotension using the area under the curve (AUC) when the MAP of the respective patient was below 90% of each baseline.
RESULTS: The patients who experienced nausea (n=45) had longer and more profound periods of hypotension than those who did not develop nausea (n=240). A comparison of AUC using MAP baseline at the last office visit or on the morning of surgery showed a statistically significant between-group difference, P=0.02, and P=0.005, respectively, and no significant between-group difference when 90% of the MAP baseline in the operating room was used.
CONCLUSIONS: Patients had the highest preoperative MAP in the operating room and the AUC was similar for those with and without nausea when the pre-spinal MAP baseline was used. Therefore, maintaining higher intraoperative blood pressure using individual pre-spinal MAP as baseline should reduce intraoperative maternal nausea.
摘要：
背景：目前的指南建议在剖宫产的腰麻期间使用预防性血管加压药，以维持术中血压高于基线值的90％。我们试图确定最佳基线平均动脉压（MAP）读数，以指导脊髓低血压的治疗。
方法：我们对2018年10月至2020年8月在三级医疗机构接受择期剖宫产的血压正常患者的数据进行了二次分析。我们比较了报告恶心的患者与未报告恶心的患者的低血压程度，使用案例控制设计。上次办公室访问时的基线地图，手术的早晨,或手术室（脊髓前）被确定。当相应患者的MAP低于每个基线的90%时,我们使用曲线下面积(AUC)计算低血压的持续时间和程度。
结果：出现恶心的患者（n=45）比没有出现恶心的患者（n=240）的低血压时间更长，更严重。在最后一次就诊或手术早晨使用MAP基线比较AUC显示，组间差异有统计学意义。P=0.02,P=0.005,当使用手术室中90%的MAP基线时，两组间无显著差异。
结论：患者在手术室中的术前MAP最高，并且当使用脊髓前MAP基线时，有恶心和无恶心的患者的AUC相似。因此,使用单独的脊髓前MAP作为基线维持较高的术中血压应减少术中产妇恶心.
方法：我们对2018年10月至2020年8月在三级医疗机构接受择期剖宫产的血压正常患者的数据进行了二次分析。我们比较了报告恶心的患者与未报告恶心的患者的低血压程度，使用案例控制设计。上次办公室访问时的基线地图，手术的早晨,或手术室（脊髓前）被确定。当相应患者的MAP低于每个基线的90%时,我们使用曲线下面积(AUC)计算低血压的持续时间和程度。
结果：出现恶心的患者（n=45）比没有出现恶心的患者（n=240）的低血压时间更长，更严重。在最后一次就诊或手术早晨使用MAP基线比较AUC显示，组间差异有统计学意义。P=0.02,P=0.005,当使用手术室中90%的MAP基线时，两组间无显著差异。
结论：患者在手术室中的术前MAP最高，并且当使用脊髓前MAP基线时，有恶心和无恶心的患者的AUC相似。因此,使用单独的脊髓前MAP作为基线维持较高的术中血压应减少术中产妇恶心.
