ABSTRACT
Objective:To explore the clinical value of ultrasonic inferior vena cava parameters in predicting supine hypotension syndrome after subarachnoid block.Methods:80 cases of cesarean section under subarachnoid block in singleton pregnancy treated in Beijing Maternity Hospital from August 2019 to March 2020 were selected retrospectively. According to the occurrence of supine hypotension syndrome after anesthesia, they were divided into two groups (group A had supine hypotension syndrome and group B did not), with 40 cases in each group. The changes of related parameters of inferior vena cava in supine position and left 30 ° lying position were compared between the two groups. The correlation between the maximum end expiratory diameter (IVCe), the minimum end inspiratory diameter (IVCi) and the collapse index (IVC-CI) of inferior vena cava and the changes of systolic blood pressure in supine hypotension syndrome were analyzed, and the value of IVCe, IVCi and IVC-CI in predicting supine hypotension syndrome were compared.Results:Under the condition of supine position and left 30 ° lying position, the levels of IVCe and IVCi in group A were significantly lower than those in group B ( P<0.05), and the levels of IVC-CI were higher than those in group B ( P<0.05). Spearman analysis showed that the levels of IVCe and IVCi were positively correlated with the changes of systolic blood pressure in the occurrence of supine hypotension syndrome ( P<0.05), and the levels of IVC-CI were negatively correlated with the changes of systolic blood pressure in the occurrence of supine hypotension syndrome ( P<0.05). IVC-CI had the highest yoden index and the highest sensitivity in predicting the occurrence of supine hypotension syndrome, and IVCe had the highest specificity in predicting the occurrence of supine hypotension syndrome. Conclusions:Cava collapse index has high sensitivity to predict supine hypotension syndrome, while the maximum end-expiratory diameter of inferior vena cava has high specificity to predict supine hypotension syndrome.
ABSTRACT
Objective@#To investigate the application of gradient cushion on prevention of supine hypotension syndrome (SHS) undergoing cesarean section.@*Methods@#450 parturients undergoing cesarean section with spinal and epidural anesthesia, aged 20-45 years, ASA Ⅰ, Ⅱor Ⅲ grades, were randomly assigned into three groups: gradient cushion group (group A), sandbag group (group B) and left-leaning-operating table group (group C), 150 cases in each. The posture intervention was alternated after completion of spinal and epidural anesthesia. Recorded the cases of SHS, and collected systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR) and saturation of pulse oximetry (SpO2) before anesthesia, 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus. And assessed the position comfort with surgical posture comfort scale.@*Results@#The incidence of SHS in group A was 8.0%(12/150), in group B was 20.0% (30/150), and in group C was 21.3% (32/150). The rate of SHS was higher in group A than other groups (χ2 value was 8.970, 10.653, all P<0.01). The score with surgical posture comfort scale was (47.03 ± 3.01), (38.13 ± 4.70), (36.10 ± 4.04), which was higher in group A than group B or group C, and the score with surgical posture comfort scale was higher in group B than group C (t value was 27.413, 30.227, 2.542, P<0.01 or 0.05). SBP and DBP were higher in group A and group B than group C at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus, and SBP and DBP were higher in group A than group B at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus, HR and RR were higher in group A and group B than group C at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus, and HR and RR were higher in group A than group B at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus (t value was -15.842-21.117, P<0.05 or 0.01).@*Conclusion@#After spinal and epidural anesthesia, applying the gradient cushion for adjustment of position would be effective to reduce the occurrence of SHS, simple to handle, decreasing to change the position and increasing to comfort after position in cesarean section.
ABSTRACT
Objective To investigate the effectiveness of predicting the incidence of supine hy-potension syndrome (SHS)after spinal anesthesia measured by ultrasonic measurement of the varia-tion of brachial artery peak velocity in different positions of parturient.Methods Parturient scheduled for elective cesarean section,ASA physical status Ⅰ or Ⅱ,were divided into SHS group and no-SHS group (SBP in the upper extremity decreased by > 30 mm Hg or decreased to < 80 mm Hg)after spinal anesthesia.HR,SBP,DBP of supine position and left lateral position before anesthesia were re-corded,and brachial artery peak velocity were measured by Ultrasonic.The differences of the above indexs before and after the transformation position were calculated.The receiver operating characteris-tic curve (ROC)was plotted by indexs of which P values were less than 0.05,to evaluate the predic-tive effect of each index on SHS after spinal anesthesia.Results Among the 196 patients,89 cases (45.4%)developed SHS after spinal anesthesia.SBP,DBP,peak velocity of brachial artery (Vpmin) and brachial artery peak velocity variation (ΔVp)were different before and after the transformation position (P<0.05).The difference in SHS group was significantly higher than no-SHS group.The areas under ROC curve (AUC)of ΔSBP,ΔDBP,ΔVpmin,ΔΔVp were 0.711 (95%CI 0.575-0.846), 0.573 (95%CI 0.419-0.727),0.948 (95% CI 0.895-0.987),0.864 (95% CI 0.770-0.958),and the cut-off values were 17.5 mm Hg,7.6 mm Hg,17.8 cm/s,and 13.1%.Conclusion The differ-ence of brachial artery peak velocity measured by ultrasonic in different positions of parturient can ef-fectively predict the occurrence of SHS,in which ΔVpmin≥ 17.8 cm/s has better predictive effect.
ABSTRACT
Objective To compare the anesthetic effect of ropivacaine and bupivacaine in combined spinal-epidural anesthesia(CSEA)for cesarean section,and their influence on the incidence rate of supine hypotension syndrome(SHS).Methods 200 patients with cesarean section surgery in our hospital from February 2016 to July 2016 were randomly divided into observation group and control group,all of cases were given CSEA.100 patients in the observation group(the group L)were given ropivacaine in spinal anesthesia,the other 100 patients in the control group(the group B)were given bupivacane in spinal anesthesia.Recorded the relevant indicators,compared the incidence rate of SHS,the effect of anesthesia and neonatal score.Results The incidence rate of SHS of the group L was lower than the group B(χ2 =9.261,P0.05).Conclusion The application of ropivacaine in CSEA for cesarean section not only has exact anesthesia effect,but also can effectively prevent SHS without any side effects.