Terapia płynowa przed i w trakcie cięcia cesarskiego

*Ewa Mayzner-Zawadzka, Elżbieta Nowacka

Summary
Background.Maternal hypotension is the most frequent complication of spinal anaesthesia for caesarean section. It is defined as a decrease in systolic blood pressure to 70-80% of the baseline recordings and/or an absolute value of <90-100 mm Hg. Several strategies have been proposed to prevent or minimize the risk of hypotension, but the ideal technique does not exist. Preload with colloid solutions seems be more effective than with crystalloids and prophylactic ephedrine is more effective than placebo.
Methods. In this multicenter retrospective study, the authors assessed fluid administration and strategies during spinal anaesthesia for caesarean section in regard to prevention and treatment of post-spinal hypotension. 2095 questionnaires were received from 21 centres in Poland. Questions included: age, weight, ASA score, type of intravenous fluid used (crystalloid or colloid solution), type of colloid (hydroxyethylstarch, gelatin solution, or dextran), volume and speed of infusion, and the requirement for vasoactive drugs and their dosage. Student´s, Mann-Whitney, and chi-square tests were used for statistical analysis.
Results. The autors analyzed 325 questionnaires reporting the strategy during spinal anaesthesia for caesarean delivery. Fluid strategy varied among different centres. Crystalloids were used in 37.2% of cases; both crystalloids and colloids were used in 60.6%, and pure colloids were used in 1.54%. When colloids were used, hydroxyethylstarch was applied in 80.2%, and gelatin solutions in 19.3%. The volume of infused colloids ranged from 15 ml to 1000 ml, and the volume of infused crystalloids ranged from 100 ml to 4000 ml. The total infused volume ranged from 500 ml to 4500 ml. The colloid/crystalloid group showed a significantly lower incidence of hypotension compared with the crystalloid group.
Conclusions. The efficacy of pre-hydration has been studied extensively in the prevention of hypotension following spinal anesthesia for caesarean delivery, but the optimum types and doses of preload solutions remains controversial. The results of study showed that colloids (mostly hydroxyethylstarch) are more effective than crystalloids.

To jest tylko fragment artykułu. Aby przeczytać całość, przejdź do Czytelni medycznej.