孕妇体重指数与蛛网膜下腔麻醉扩散的关系:一项随机对照试验

贵州医科大学麻醉与心脏电生理课题组

翻译 : 安丽 

编辑 : 严旭  

审校 : 曹莹

背景:蛛网膜下腔麻醉是剖宫产手术的常用麻醉方式，据报道肥胖的产妇对局麻药的用量存在较大的差异，一些人建议在病态肥胖女性中减少蛛网膜下腔麻醉局麻药的用量，也有研究发现体重指数(BMI)与剖宫产时布比卡因的使用无相关性。故目前体重指数(BMI)对蛛网膜下腔麻醉扩散的影响尚不完全清楚。本研究的目的是确定不同BMI孕妇，在剖宫产术中对罗哌卡因剂量的需求和低血压的发生率。

方法：在这项双盲研究中，405名接受择期剖宫产的产妇根据BMI分为3组：分别为：S组（BMI＜25 kg/m2）、M组（25≤BMI＜30kg/m2）和L组（BMI≥30kg/m2）。每组中的产妇进一步分别接受7、8、9、10、11、12、13、14或15 mg的罗哌卡因行蛛网膜下腔麻醉。本研究的主要观察指标为蛛网膜下腔麻醉的成功率或失败率。蛛网膜下腔给药后15 min内平面感觉消失的水平未达到T6，或患者要求额外镇痛或视觉模拟疼痛量表(VAPS)评分≥40 mm，记为蛛网膜下腔麻醉失败；另并记录蛛网膜下腔麻醉后最低MAP、MAP变化情况、低血压发生率及麻黄碱使用总量。

结果：S组罗哌卡因的ED50和ED95分别为9.487 mg和13.239 mg, M组罗哌卡因的ED50和ED95分别为9.984 mg和13.737 mg,L组罗哌卡因的ED50和ED95分别为9.067 mg和12.819 mg, 3组间差异无统计学意义(P=0.915)。腰麻后L组低血压发生率及MAP变化幅度均高于其他2组，且当罗哌卡因剂量为15 mg时，L组麻黄碱用量高于其他2组。低血压发生率分别与罗哌卡因剂量(OR=1.453,P= 0.001)和胎龄(OR=1.894,P= 0.001)呈正相关。

结论：在正常BMI范围内，蛛网膜下腔麻醉罗哌卡因所需剂量相似。然而，与非肥胖患者相比，肥胖患者低血压的发生率和严重程度与更高剂量的罗哌卡因增加有关。

原始文献来源 ： 

Huai-Zhen Wang，Han-Wen Chen，Yan-Ting Fan，Xing-Rong Song and Ying-Jun She.Relationship Between Body Mass Index and Spread of Spinal Anesthsia in Pregnant Women: A Randomized Controlled Trial.Med Sci Monit, 2018; 24: 6144-6150.DOI: 10.12659/MSM.909476. 

英文原文

Relationship Between Body Mass Index and 

Spread of Spinal Anesthsia in Pregnant Women: 

A Randomized Controlled Trial

Abstract 

Background:The effect of body mass index (BMI) on the spread of spinal anesthesia is not completely clear. The aim of this study was to determine the dose requirements of ropivacaine and the incidence of hypotension in pregnant women with different BMIs during cesarean delivery.

Methods: In this double-blind study, 405 women undergoing elective cesarean delivery were allocated to group S (BMI <25), group M (25 £BMI <30), or group L (BMI ³30). Women in each group were further assigned to receive 7, 8, 9, 10, 11, 12, 13, 14, or 15 mg of spinal ropivacaine.

Results: The ED50 and ED95 values of ropivacaine were 9.487 mg and 13.239 mg in Group S, 9.984 mg and 13.737 mg in Group M, and 9.067 mg and 12.819 mg in Group L. There were no significant differences among the 3 groups (p=0.915). Group L had a higher incidence of hypotension and a greater change in MAP after spinal anesthesia compared to the other 2 groups, and also required more doses of ephedrine than the other 2 groups when a dose of 15 mg ropivacaine was used. The incidence of hypotension had a positive correlation with the dose of ropivacaine (OR=1.453, p<0.001) and gestational age (OR=1.894, p<0.001).

Conclusions:Spinal ropivacaine dose requirements were similar in the normal BMI range. However, higher doses of spinal ropivacaine were associated with an increased incidence and severity of hypotension in obese patients compared with that in non-obese patients.

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