背景:钙,一种生理离子,引起血管收缩,对心脏有积极的离子作用。已建议使用它来预防脊髓后低血压,但从未对剖腹产患者进行正式评估。这项研究调查了钙对产妇的血液动力学影响,主要目的是比较脊髓后低血压的发生率。
方法:将60名计划剖宫产的健康足月妊娠患者随机分为两个相等的组,在心电图监测下立即通过注射泵在20分钟内接受葡萄糖酸钙或正常盐水推注。脊髓麻醉后患者仰卧位。基线时记录血压和心率,并在脊髓后定期。在输注之前和之后估计母体钙水平。分析新生儿血气分析及血钙水平。两组均记录了甲苯丁胺的总需求量。
结果:葡萄糖酸钙组的心率值与基线值相当,在8、12和16min时显著下降。与基线值相比,两组的血压从4分钟开始显着降低。然而,两组在所有时间点均具有可比性(0.622).葡萄糖酸钙组中有19例患者(63.33%)需要输注美芬特明,而正常盐水组中有23例患者(76.6%)需要输注美芬特明以维持收缩压。(p=0.791)葡萄糖酸钙组的脐静脉pH(p=0.038)和二氧化碳分压(p=0.038)明显优于葡萄糖酸钙组。
结论:用于预防剖腹产健康产妇低血压的钙降低了血管加压药的需要量和甲苯丙胺的总剂量,但差异无统计学意义。
BACKGROUND: Calcium, a physiological ion, causes vasoconstriction and has a positive ionotropic action on heart. Its use to prevent post-spinal hypotension has been suggested but never formally evaluated for patients undergoing caesarean section. This
study investigated the hemodynamic effects of calcium administration in parturients with the primary aim of comparing the incidence of post-spinal hypotension.
METHODS: Sixty healthy full-term pregnant patients scheduled for caesarean section were randomly allocated to two equal groups to receive either calcium gluconate or normal Saline bolus over 20min by syringe infusion pump under electrocardiography monitoring immediately after the patient was turned supine following spinal anaesthesia. Blood pressure and heart rate were recorded at baseline, and at regular intervals following spinal. Maternal calcium levels were estimated before and after infusion. Neonatal blood gas analysis and calcium level were analyzed. Total mephentermine requirement was recorded in both groups.
RESULTS: The heart rate values remained comparable to baseline value in group calcium gluconate while in group normal Saline, it decreased significantly at 8,12 and 16min. Blood pressure decreased significantly as compared to the baseline value from 4min onwards in both the groups. However, it was comparable in the two groups at all time points(0.622). Nineteen patients(63.33%) required mephentermine infusion in group calcium gluconate as compared to 23 patients(76.6%) in group normal Saline for maintenance of systolic blood pressure.(p=0.791) Umbilical venous pH (p=0.038) and partial pressure of carbon dioxide(p=0.038) were significantly better in group calcium gluconate.
CONCLUSIONS: Calcium used for prophylaxis of hypotension in healthy parturients undergoing caesarean section reduced the vasopressor requirements and total mephenteramine dose, but the difference did not attain statistical significance.