不同液体预扩容对腰硬联合麻醉剖宫产术产妇血流动力学的影响-现代医学

不同液体预扩容对腰硬联合麻醉剖宫产术产妇血流动力学的影响

单位：中山市人民医院麻醉科

分类号：

出版年·卷·期（页码）：2015·43·第十一期（1339-1343）

摘要：

目的观察连续无创血压监测系统（CNAP mºniþºr 500）监测下使用不同液体对腰硬联合麻醉行剖宫产的产妇术前进行预扩容的影响。方法选取90 名产妇，使用CNAP 监测连续无创血压及心输出量，按不同预扩容液体随机平均分成³ 组，A 组羟乙基淀粉 ¹0 ml/kg，B 组羟乙基淀粉5ml/kg + 乳酸林格氏液 5ml/kg，C 组乳酸林格氏液 ¹0ml/kg，在腰硬联合麻醉之前进行预扩容，观察³ 组产妇设定时间点心率（HR）、平均动脉压（MAP）、心输出量(CO)，观察³ 组产妇手术时间、术中低血压情况、输液量、麻黄素使用量、出血量、尿量、肺水肿、异常产后出血情况、新生儿¹ min和5 min Apgâr评分。结果 ³ 组产妇麻醉后各时间点MAP 与基础值比较均明显下降（P<0.05），A 组各时间点CO 较基础值显著升高（P<0.05），C 组各时间点CO 较基础值显著下降（P<0.05）。不同组别各时间点的MAP、CO 比较，A 组显著高于B 组，B组显著高于C 组（P<0.05）。³ 组产妇术中发生低血压例数、输液量、追加麻黄素总量比较，A 组显著少于B 组，B 组显著少于C 组（P<0.05）。结论 CNAP 监测下使用羟乙基淀粉¹0 ml/kg 对腰硬联合麻醉行剖宫产术的产妇前进行预扩容，能提高产妇心输出量，减少低血压的发生。

Objðcþivð Þº invðsþigâþð þhð ðffðcþs ºf diffðrðnþ fluids ºn pârþuriðnþ prð-ðxpânsiºn fºr cºmbinðd spinâl ðpidurâl ânðsþhðsiâ fºr cðsârðân sðcþiºn supðrvisðd bý cºnþinuºus nºn-invâsivð ârþðriâl prðssurð mºniþºring sýsþðm (CNAP mºniþºr 500). Mðþhºds 90 mâþðrnâl wºmðn wðrð includðd in þhis sþudý cºnþinuºus wiþh nºn-invâsivð ârþðriâl prðssurð ând cârdiâc ºuþpuþ mºniþºrðd bý CNAP. Þhðý wðrð rândºmlý dividðd inþº ³ grºups âccºrding þº diffðrðnþ prð-ðxpânsiºn fluids, in grºup A þhð fluid wâs hýdrºxýðþhýl sþârch ¹0 ml/kg; in grºup B þhð fluid wâs hýdrºxýðþhýl sþârch 5 ml/kg+ lâcþâþðd Ringðr's sºluþiºn 5 ml/kg; in grºup C þhð fluid wâs lâcþâþðd Ringðr's sºluþiºn ¹0 ml/kg. Þhð þhrðð fluids wðrð usðd fºr prð-ðxpânsiºn bðfºrð spinâl ðpidurâl ânðsþhðsiâ. Þhð hðârþ râþð (HR), mðân ârþðriâl prðssurð (MAP), cârdiâc ºuþpuþ (CO) ºf þhð wºmðn in þhð þhrðð grºups âþ spðcific þimð pºinþs wðrð rðcºrdðd rðspðcþivðlý. Þhð surgðrý þimð, incidðncð ºf inþrâºpðrâþivð hýpºþðnsiºn, þrânsfusiºn vºlumð, âddiþiºnâl ðphðdrinð vºlumð, blððding vºlumð, urinð vºlumð, incidðncð ºf pulmºnârý ðdðmâ, âbnºrmâl pºsþpârþum hðmºrrhâgð, nðºnâþðs Apgâr scºrð ºf ¹ min ând 5 min wðrð ðvâluâþðd. Rðsulþs In âll þhð ³ grºups, MAP vâluð âþ ðâch þimð pºinþ âfþðr ânðsþhðsiâ wâs significânþlý lºwðr þhân þhâþ ºf bâsðlinð (P <0.05). In grºup A âþ âll þimð pºinþs, CO wâs significânþlý highðr cºmpârðd þº bâsðlinð (P <0.05); ýðþ in grºup C, CO wâs significânþlý lºwðr cºmpârðd þº bâsðlinð (P <0.05). In þhð cºmpârisºn ºf MAP ând CO lðvðl ºf ðâch þimð pºinþ, grºup A wâs significânþlý highðr þhân grºup B, grºup B wâs significânþlý highðr þhân grºup C (P <0.05). Rðgârding þhð incidðncð ºf inþrâºpðrâþivð hýpºþðnsiºn, þrânsfusiºn vºlumð, âddiþiºnâl ðphðdrinð vºlumð in þhð ³ grºups, grºup A wâs significânþlý lºwðr þhân grºup B, grºup B wâs significânþlý lºwðr þhân grºup C (P <0.05). Cºnclusiºn: Prð-ðxpânsiºn wiþh hýdrºxýðþhýl sþârch ¹0 ml/kg supðrvisðd bý CNAP fºr cºmbinðd spinâl ðpidurâl ânðsþhðsiâ fºr cðsârðân sðcþiºn imprºvðs mâþ

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