连续无创血压(CNAP)与传统无创血压(NIAP)在剖宫产脊椎麻醉后血压监测中的比较

Impact of continuous non-invasive arterial pressure(CNAP) and non-invasive arterial pressure(NIAP) monitoring on hemodynamic fluctuation during spinal anaesthesia for cesarean section

目的研究与传统无创血压(non-invasive arterial pressure,NIAP)监测相比,剖宫产脊椎麻醉(简称脊麻)时连续无创血压(continuous non-invasive arterial pressure,CNAP)监测是否有利于维持产妇血流动力学稳定。方法选择ASAⅠ~Ⅱ级,择期在脊麻下行剖宫产手术的产妇40例,采用随机数字表法将产妇分为2组,CNAP组(CS组)和NIAP组(N组)。血压的管理采用相同的方案,N组根据NIAP测定的血压数据,CS组根据CNAP测得的数据。我们比较了CNAP与NIAP监测的准确性和精确性,使用Bland-Altman散点图对获得的数据进行统计学分析。并记录两组产妇脊麻后低血压出现时间、低血压的发生率和血流动力学稳定的时间。结果根据2 270对数据,CNAP与NIAP在SBP、DBP和MAP平均偏倚(NIAP-CNAP)和标准差分别为(-4±14)mmHg、(-9±14)mmHg和(-6±13)mmHg。脊麻后两组严重低血压发生率CS组明显低于N组(11.1%vs.28.9%,P=0.035),CS组血流动力学的稳定时间明显长于N组(93.5%vs.83.7%,P=0.01)。结论与NIAP监测相比,剖宫产脊麻时CNAP监测有利于维持产妇血流动力学的稳定。

Objective To assess the ability of a continuous non-invasive arterial pressure(CNAP)monitoring system to reduce intra-anesthetic hemodynamic fluctuation during caesarean section compared with non-invasive intermittent arterial pressure(NIAP) measurement.Methods Fourty healthy women scheduled for planned cesarean delivery under spinal anesthesia were recruited for this study.They were divided into two groups:continuous non-invasive arterial pressure device(Group CS,n=20) and intermittent oscillometric arterial pressure measurement(Group N,n=20),by using a computer-generated random number table.Blood pressure(BP) management was performed using the same protocol,with BP measured by intermittent BP cuff(i.e.,NIAP measurement) in Group N or by CNAP monitoring in Group CS.We assessed the accuracy and precision of the CNAP and NIAP measurement using Bland-Altman.Additionally,the time of hypotension after spinal anesthesia,the incidence of hypotension and the duration of hemodynamic stability were recorded.Results From 2 270 arterial pressure readings,biases(SD) for NIAP-CNAP for systolic blood pressure(SBP),diastolic blood pressure(DBP) and mean blood pressure(MBP) for all patients were(-4±14 mmHg),(-9±14 mmHg) and(-6±13 mmHg),respectively.Severe hypertension occurred less frequently in Group CS than in Group N after spinal anesthesia(11.1%vs.28.9%,P=0.035).The duration of hemodynamic stability(systolic BP 80%-110% of baseline)intraoperatively was longer in the Group CS than in the Group N(93.5% vs.83.7%,P=0.01).Conclusion CNAP monitoring may improve hemodynamic stability in the parturients during spinal anaesthesia compared with NIAP measurement.