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首页> 外文期刊>International journal of obstetric anesthesia >Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery.
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Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery.

机译：Hetastarch联合加载与预加载一样有效，可防止剖宫产脊髓麻醉后发生低血压。

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BACKGROUND: Pre-loading with hetastarch decreases the incidence and severity of hypotension after spinal anesthesia for cesarean delivery. However, pharmacokinetic studies with crystalloid predict that fluid loading should be more efficacious if rapidly administered immediately after induction of spinal anesthesia. The aim of this study was to compare pre- and co-loading of hetastarch for the prevention of hypotension following spinal anesthesia for cesarean delivery. METHODS: Forty-six healthy term parturients scheduled for cesarean delivery were randomized to receive 500 mL of 6% hetastarch intravenously, either slowly before spinal anesthesia (pre-loading) or as quickly as possible immediately after spinal anesthesia (co-loading). Systolic blood pressure was maintained at or above 90% of baseline with intravenous vasopressor boluses (ephedrine 5mg/mL+phenylephrine 25 microg/mL). The primary outcome was the volume of vasopressor mix required. Secondary outcomes included blood pressure and heart rate changes, time to first vasopressor use, nausea or vomiting, and neonatal outcomes (umbilical artery and vein pH, Apgar scores). RESULTS: The pre-loading group used 3.5+/-2 mL (mean+/-SD) of vasopressor mixture compared with 3.2+/-3 mL in the co-loading group (P=0.6). There were no differences in any important maternal hemodynamic or neonatal outcome values between the two study groups. CONCLUSION: Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension after spinal anesthesia for cesarean delivery. Surgery need not be delayed to allow a predetermined pre-load to be administered before induction of spinal anesthesia.
机译：背景：使用头孢曲霉毒素预加载可降低剖宫产脊髓麻醉后低血压的发生率和严重程度。但是，有关晶体的药代动力学研究预测，如果在诱导麻醉后立即迅速给药，液体负荷应更有效。这项研究的目的是比较hetastarch的预负荷和共同负荷，以预防剖宫产脊髓麻醉后的低血压。方法：随机安排接受剖腹产的46名健康足月产妇静脉注射500毫升6％的hetastarch，或者在麻醉前缓慢加载（预负荷），或者在麻醉后立即尽快加载（联合负荷）。使用静脉血管升压药（麻黄碱5mg / mL +去氧肾上腺素25microg / mL）将收缩压维持在基线的90％或以上。主要结局是所需升压药混合物的量。次要结局包括血压和心率变化，首次使用升压药的时间，恶心或呕吐以及新生儿结局（脐动脉和静脉pH，Apgar评分）。结果：预负荷组使用的血管升压药混合物为3.5 +/- 2 mL（平均+/- SD），而共同负荷组为3.2 +/- 3 mL（P = 0.6）。在两个研究组之间，任何重要的母亲血液动力学或新生儿结局值均无差异。结论：Hetastarch联合加载与预加载一样有效，可预防剖宫产脊髓麻醉后的低血压。不需要延迟手术以允许在诱导脊髓麻醉之前进行预定的预负荷。

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