Intravenous Pretreatment of Hypertonic Saline Can Prevent Systemic Hypotension Induced by Spinal Anesthesia

經靜脈預先注射高張食鹽水溶液可有效預防因脊髓麻醉引起之全身性低血壓

王博文(Bo-Wen Wang) ； 邱耀輝(Yaw-Huei Chiou) ； 陳文彬(Wen-Bin Chen) ； 彭子瑜(Tsu-Yu Peng) ； 梁灝根(Ho-Kagn Leung)

《Acta Anaesthesiologica Sinica》 35卷2期 (1997/06) Pp. 85-90

摘要

Background: Hypertonic saline improves organ perfusion and patient survival during hemorrhagic shock because it expands plasma volume and increases tissue oxygenation. Its beneficial results have been reported in patients suffering from hypotension during spinal anesthesia. The purpose of this study was to compare the influence between prehydration with 3% hypertonic saline and with isotonic lactated Ringer's solution on the hemodynamic changes and serum electrolyte concentrations in patients undergoing spinal anesthesia. Methods: Sixty ASA class I patients scheduled for herniorrhapy under spinal anesthesia were assigned randomly into two groups. Group 1 = patients were prehydrated with isotonic lactated Ringer's solution at 7 mg/kg (n = 30); Group 2 = patients were given prehydration with 3% hypertonic saline at 7 ml/kg (n = 30). Following prehydration, arterial blood pressure and heart rate were recorded and serum electrolyte concentrations were measured. Results: The incidence of hypotension was 17/30 (57%) in the isotonic lactated Ringer's solution group as against 7/30 (23%) in the hypertonic saline group (p ＜ 0.05). There was no significant difference between two groups in relation to the level of anesthesia or maximal heart rate, and electrolyte imbalance did not occur in either group. Conclusions: Prior to spinal anesthesia, hydration with small amount of hypertonic saline is effective to minimize hypotension associated with spinal anesthesia. If so administered it would not increase bodily sodium load and unlike isotonic crystalloid solution it dose not cause accumulation of water in the body on equipollent basis.

關鍵字

Anesthesia: spinal ； Saline solution: hypertonic ； Complications: hypotension

並列摘要

背景：高張食鹽水溶液，當使用於出血性休克的病人，可以成功的恢復其心臟血管系統的功能，也有報告指出高張食鹽水溶液可預防脊髓麻醉所導致的低血壓。本實驗研究疝氣手術需接受脊髓麻醉的病人，預先給予晶體溶液或高張食鹽水溶液之後血液動力學及血中電解質濃度的變化。方法：本研究將60位接受疝氣手術，脊髓麻醉的病人，隨機分為二組，第一組：（n =30）預先給予晶體溶液7 ml/kg，第二組：（n =30）則給予高張食鹽水溶液7 ml/kg，之後記錄血液動力學及血中電解質濃度的變化。結果：第一組病人發生低血壓的機率為17/30（57%），第二組病人為7/30（23%），具有統計學上的差異。脊髓麻醉的高度，血中電解質濃度的變化在二組病人並沒有明顯的不同。結論：預先靜脈注射少量高張食鹽水溶液可以有效的預防脊髓麻醉所導致的低血壓，不會增加體內鈉離子的負荷，且沒有傳統方式讓大量等張溶液在體內堆積的缺點。

並列關鍵字

麻醉：脊髓 ； 生理食鹽水溶液：高張性 ； 併發症：低血壓