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首页> 外文期刊>Journal of Clinical and Diagnostic Research >The Correlation between Body Mass Index and Vasopressor Need after Spinal Anaesthesia for Cesarean Section
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The Correlation between Body Mass Index and Vasopressor Need after Spinal Anaesthesia for Cesarean Section

机译：剖宫产术中脊髓麻醉后体重指数与血管加压药需求的相关性

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Hypotension is one of the common complications of spinal anaesthesia in mothers undergoing cesarean delivery. Vasopressor such as ephedrine or phenylephrine are the most common drugs employed to treat hypotension induced by spinal anaesthesia. Obese women have a limited physiological reserve and usually show remarkably greater complications of pregnancy and anaesthesia.Aim: To compare the requirement of vasopressor therapy for spinal anaesthesia-induced hypotension, between parturients with BMI =30 kg/m2 and those with BMI <30 kg/m2 in cesarean section.Materials and Methods: The study population included 160 healthy singleton pregnant women aged between 18 and 40 years of age with term pregnancy who underwent elective cesarean section with spinal anaesthesia. Spinal anaesthesia was performed, using 10 mg of hyperbaric bupivacaine 0.5% plus 10 μg of fentanyl. Any fall of >20% in Mean Arterial Pressure (MAP) or reduction of systolic blood pressure below 100 mmHg was considered as hypotension; it was treated with intravascular fluid, ephedrine, or phenylephrine. At the end of the study, the participants were divided, based on their Body Mass Index (BMI), into normal and obese groups (BMI <30 kg/m2 or =30 kg/m2, respectively). Using SPSS statistical software, authors compared numbers of hypotension episode, need for vasopressor, and newborn status between the two groups.Results: The mean±SD BMI of all patients was 33.24±5.73 kg/m2. In 51 mothers (31.9%), the BMI was below 30 kg/m2 and mean±SD BMI was 27.24±2.24 kg/m2. In 109 mothers (68.1%), the BMI was =30 kg/m2 and mean±SD BMI was 36.11±4.54 kg/m2. In 126 (79.7%) cases, the main indication for cesarean section was a previous experience of cesarean child-birth. Spinal anaesthesia failed in two cases (with BMI =30 kg/m2) and was changed to general anaesthesia. These mothers were excluded from the study, and the data were obtained from 158 cases. Intraoperative fluid requirement and blood loss were similar in normal and obese mothers. Hypotension rate was similar; however, in the majority of the cases, MAP was low in obese mothers. Ephedrine was administered more frequently and with high doses in obese mothers. Phenylephrine was employed in the similar manner. The newborn Apgar scores and umbilical cord acidosis rate were similar in both the groups.Conclusion: It was found that the fall in arterial blood pressure was more severe in obese mothers after spinal anaesthesia. Vasopressor was required more frequently and in high doses in these obese mothers. Furthermore, a good newborn outcome can be delivered with appropriate haemodynamic management.
机译：低血压是剖宫产母亲脊柱麻醉的常见并发症之一。诸如麻黄碱或去氧肾上腺素之类的升压药是用于治疗由脊髓麻醉引起的低血压的最常用药物。肥胖女性的生理储备有限，通常表现出明显的妊娠和麻醉并发症。目的：为了比较在BMI = 30 kg / m2的产妇和BMI的产妇中，使用血管加压药治疗脊柱麻醉引起的低血压的需求。剖宫产<30 kg / m2。材料与方法：研究人群包括160名年龄在18至40岁之间的足月妊娠健康单身孕妇，她们接受了选择性剖宫产并进行了麻醉。使用10 mg 0.5％的高压布比卡因加10μg芬太尼进行脊髓麻醉。平均动脉压（MAP）下降> 20％或将收缩压降至100 mmHg以下均被视为低血压;用血管内液，麻黄碱或去氧肾上腺素治疗。在研究结束时，根据体重指数（BMI）将参与者分为正常组和肥胖组（BMI <30 kg / m2或= 30 kg / m2）。使用SPSS统计软件，作者比较了两组之间的低血压发作次数，需要的升压药和新生儿状态。结果：所有患者的平均值±SD BMI为33.24±5.73 kg / m2。在51名母亲中（31.9％），BMI低于30 kg / m2，平均值±SD BMI为27.24±2.24 kg / m2。 109名母亲（68.1％）的BMI为= 30 kg / m2，平均值±SD BMI为36.11±4.54 kg / m2。在126例（79.7％）病例中，剖宫产的主要指征是以前有过剖宫产的经历。脊柱麻醉失败2例（BMI = 30 kg / m2），改为全身麻醉。这些母亲被排除在研究之外，数据来自158例。正常和肥胖母亲的术中液体需求量和失血量相似。低血压发生率相似;但是，在大多数情况下，肥胖母亲的MAP偏低。在肥胖的母亲中，麻黄碱的使用频率更高，剂量更高。苯肾上腺素以类似方式使用。两组的新生儿Apgar评分和脐带酸中毒率相似。结论：发现肥胖的母亲在脊髓麻醉后动脉血压的下降更为严重。在这些肥胖的母亲中，更频繁地需要大剂量的升压药。此外，适当的血液动力学管理可以带来良好的新生儿预后。

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