晶体联合胶体预扩容对行腰麻下剖宫产术产妇及新生儿的影响-现代医学

晶体联合胶体预扩容对行腰麻下剖宫产术产妇及新生儿的影响

单位：1. 眉山市东坡区妇幼保健院麻醉科, 四川眉山 6200102;
2. 成都市双流区妇幼保健院麻醉科, 四川成都 610200

分类号：R719.8;R614

出版年·卷·期（页码）：2020·39·第四期（526-530）

摘要：

目的：评价晶体联合胶体预扩容在腰麻下剖宫产手术产妇中的应用效果。方法：以2016年1月至2017年12月我院120例于腰麻下初次行剖宫产术的足月单胎待产妇为研究对象，依据术前液体预扩容方式采用随机软件将产妇随机分为晶体联合胶体预扩容组（T组）60例与晶体预扩容组（C组）60例。T组产妇入室后静脉滴注0.9%氯化钠注射液500 ml加羟乙基淀粉130/0.4氯化钠注射液500 ml，C组产妇入室后静脉滴注0.9%氯化钠注射液1 000 ml。两组产妇预扩容液体均于手术开始前滴注完毕。记录两组产妇术中最低收缩压和最低心率值、术中低血压人数、严重低血压人数及术中心动过缓人数。记录术中补液量、麻黄碱使用量、麻黄碱使用人数、恶心呕吐人数及胎儿娩出后1、5 min新生儿Apgar评分。结果：两组产妇术中最低收缩压和最低心率差异无统计学意义（P>0.05），术中低血压、严重低血压、心动过缓发生率差异无统计学意义（P>0.05），术中补液量、麻黄碱使用量、麻黄碱使用人数差异无统计学意义（P>0.05），术中恶心呕吐发生率差异无统计学意义（P>0.05）。两组新生儿出生后1、5 min Apgar评分差异无统计学意义（P>0.05）。结论：与晶体预扩容相比，晶体联合胶体预扩容用于预防腰麻后低血压并未体现出明显优势。

Objective: To investigate the effect of colloid combined crystalloid preload during spinal anesthesia in patients undergoing cesarean delivery. Methods: 120 Patients for elective cesarean delivery undergoing spinal anesthesia in our hospital from January 2016 to December 2017 were randomly divided into two groups. Group T:intravenous 0.9% sodium chloride injection 500 ml and hydroxyethyl starch 130/0.4 sodium chloride injection before operation; Group C:intravenous 0.9% sodium chloride injection 1 000 ml before operation. The lowest systolic blood pressure and heart rates, the incidences of hypotension, severe hypotension and bradycardia were recorded in the two groups during operation. The amount of perioperative fluids, the dosage of ephedrine, the rate of ephedrine usage, the number of nausea and vomiting during operation and Apgar scores at 1 min and 5 min after delivery were documented.Results: There was no significant difference in the lowest systolic blood pressure and heart rates between two groups (P>0.05). There was no significant difference in the incidences of hypotension, severe hypotension and bradycardia between two groups (P>0.05). There were no significant difference in the amount of perioperative fluids, the dosage of ephedrine and the rate of ephedrine usage between two groups(P>0.05). There was no significant difference in the incidence of nausea and vomiting and the APGAR scores of neonates after birth between two groups (P>0.05).Conclusion: Compared with crystalloid preload, colloid combined crystalloid preload do not have obvious advantages during spinal anesthesia in patients undergoing cesarean delivery. Due to the limited quantity of this study, the above conclusion still need more clinical trails to be verified.

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