腹内压力对最大鞘内感觉阻滞水平的影响:一项初步随机对照试验

IF 0.2 Q4 ANESTHESIOLOGY
Jubin Jakhar, Michell Gulabani, A. Tyagi, A. Sethi
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引用次数: 0

摘要

目的:腹腔内压(IAP)升高通常被认为是鞘内剂量节省的原因,从而导致妊娠期间感觉阻滞水平升高。然而,评估这种关系的实际数据很少。因此,我们旨在评估IAP与剖宫产鞘内注射高压布比卡因和左旋布比卡因后最大感觉阻滞水平之间的关系。方法:初步随机对照盲法试验包括18-40岁的女性,计划在单次蛛网膜下腔阻滞下进行选择性剖宫产。随机分组后,他们接受鞘内高压布比卡因(H组)或普通(等压)左旋布比卡因治疗(P组),剂量为12.5mg(每组n=40)。采用推荐的膀胱内灌注技术,在脊椎阻滞前后测量IAP。测量每位患者的最大感觉阻滞水平和IAP。结果:H组(P=0.334;rs=-0.157)或P组(P=0.637;rs=-0.078)的椎前IAP与感觉阻滞最大水平无显著相关性;H组和P组的蛛网膜下腔压相似(分别为15.9[14.3-18.2]和15.3[14.3-17.4]mmHg)(P=0.474);以及脊髓后IAP(分别为15.2[13.8-17.2]和14.6[13.4-16.0]mmH,g)(P=0.029)。在辅助观察中,P组的感觉阻滞持续时间明显长于H组(133.6±24.2和103±23.4分钟;P<0.0000)。然而,感觉和运动阻滞的最大水平,实现它们所需的时间,以及术中低血压和心动过缓的发生率在H组和P组之间具有统计学相似性(P>0.05)。然而,尽管棘前或棘后IAP增加,但与感觉阻滞的最大水平没有任何显著关联(P>0.05)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of intra-abdominal pressure on maximum level of intrathecal sensory block: A preliminary randomized controlled trial
Objectives: Increase in Intra-Abdominal Pressure (IAP) is commonly accepted as a cause for intrathecal dose sparing and consequently higher level of sensory block during pregnancy. There is however very little actual data evaluating the relationship. Thus, we aimed to evaluate association between IAP and maximum level of sensory block following intrathecal injection of hyperbaric bupivacaine as well as plain levobupivacaine for cesarean section. Methods: Preliminary randomized controlled blinded trial included females aged 18-40 years, scheduled for elective cesarean section under single-shot subarachnoid block. After randomization, they received either intrathecal hyperbaric bupivacaine (group H) or plain (isobaric) levobupivacaine (group P) in a dose of 12.5 mg (n = 40 each). IAP was measured before and after the spinal block, using the recommended intravesical technique. The maximum level of sensory block and the IAPs were measured in each patient. Results: There was no significant correlation of IAPprespinal with maximum level of sensory block for group H (P = 0.334; rs = -0.157) or group P (P = 0.637; rs = -0.078). Similarly, there was no significant correlation of the IAPpostspinal: group H (P = 0.370; rs = -0.145); and group P (P = 0.714; rs = -0.061). Both group H and group P had similar IAPprespinal (15.9 [14.3-18.2] and 15.3 [14.3-17.4] mmHg, respectively) (P = 0.474); as well as IAPpostspinal (15.2 [13.8-17.2] and 14.6 [13.4-16.0] mmH, g respectively) (P = 0.239). Among ancillary observations, duration of sensory block was significantly longer for group P versus group H (133.6 ± 24.2 and 103 ± 23.4 mins; P < 0.000). However, the maximum levels of sensory and motor block, respective times required to achieve them, as well as incidences of intraoperative hypotension and bradycardia were statistically similar between group H and group P (P > 0.05). Conclusions: The IAP was raised to the level of conventionally defined intra-abdominal hypertension (>12 mmHg) in patients scheduled for elective cesarean section. However, despite being increased, the IAPprespinal or IAPpostspinal did not show any significant association with the maximum level of sensory block (P > 0.05).
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