胶体液预扩容联合预注血管活性药对产妇腰-硬联合麻醉后血流动力学的影响被引量：25

The effects of colloid preloading with vasopressors on haemodynamics for cesarean section under CSEA

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摘要目的研究胶体液预扩容联合预注小剂量血管活性药对剖宫产腰-硬联合麻醉(CSEA)后产妇血流动力学及新生儿血气和Apgar评分的影响。方法择期行CSEA下剖宫产术的产妇60例,于麻醉前30min输入6%羟乙基淀粉130/0.415ml·kg-1·h-1,扩容完成后行腰麻穿刺。随机均分为:胶体液+麻黄碱组(HES-E组)、胶体+去氧肾上腺素组(HES-P组)、胶体组(HES-C组)。HES-E组静脉泵注麻黄碱8mg;HES-P组泵注去氧肾上腺素100μg;HES-C组泵入等容量1ml生理盐水。监测麻醉前(基础值,T1)、扩容后(T2)以及麻醉后2、3、5、10min(T3～T6)、切皮时(T7)、手术结束(T8)的MAP、HR及CO等,记录产妇低血压以及恶心呕吐发生率。记录新生儿Ap-gar评分及脐带血气分析。结果 HES-E、HES-P组低血压发生率明显低于HES-C组(P<0.05)。与T1时比较,T3～T5时HES-E组和T4、T5HES-C组HR明显增快、而T3～T5时HES-P组HR明显减慢(P<0.05);T4、T5时HES-C组MAP明显降低(P<0.05);T3～T6时HES-P、HES-C组CO明显下降(P<0.05)。与HES-C组比较,T3～T6时HES-E、HES-P组MAP明显升高(P<0.05);T3～T5时HES-E组CO明显升高(P<0.05)。三组新生儿脐血的pH值、PCO2、PO2、Lac、BE以及Apgar评分差异无统计学意义。结论胶体液的预扩容联合小剂量的血管活性药预注减少了低血压和恶心呕吐的发生率,积极有效地防治剖宫产术CSEA中所致的低血压,并且不会引起胎儿脐血pH、BE值的下降。 Objective To study the maternal and fetal effect of colloid preloading with prophylactic infusion of vasopressors on haemodynamics and Apgar score for cesarean section under CSEA. Methods Sixty patients undergoing elective cesarean section under CSEA were administered with 15 ml. kg^-1·h^-1 of HES 130/0. 4 half an hour before anesthesia Patients were randomized into 3 groups. Patients in group HES-E received 8 rng of ephedrine intravenously; Patients in group HES-P received 100 mg of phenylephrine intravenously and group HES-C patients received equal dose of saline MAP, HR and CO were monitored at 5 min after admission to operation room（T1 ）, after preloading（T2）, 2, 3, 5 and 10 min after spinal anesthesia administration（T3-T6 ）, at skin incision（T7 ） and at the end of surgery（T8 ）. The incidence of hypotension and nausea was also recorded. Neonatal status was assessed by Apgar score and umbilical cord blood gas analysis. Results The incidence of hypoterksion was lower in groups HES-E and HES-P than that in groups HES-C （P〈0. 05）. HR sped up at T4 ,T5 after anesthesia compared to T1 in group HES-C （P〈0. 05）. HR slowed down in group HES-P while it sped up in group HESE at Ta-T5 after anesthesia （P〈0. 05）. After anesthesia, MAP of group HES-C mildly declined at T4 ,＇Is 6ampared to that at T1. MAP of group HES-C at T4 ,T5 was lower than that of groups HES-E and HES-P （P〈0. 05）. CO was lower at Ta-T6 than that at T1 in groups HES-C and HES-P （P〈0.05）. CA） of group HES-E was stable after anesthesia, it was higher at Ta-Ts compared to group HES-C （P〈0.05）. No statistical differences were found in pH, PCOe, POe and Lac, BE in umbilical cord blood gas analysis and Apgar scores among the {hree groups. Coclusion Preloading with 15 ml· kg^-1. h^-1 of HES 130/0. 4 prior to CSEA followed by prophylactic infusion of vasopressors could effectively reduce the incidence of hypotension, nausea and vomiting without affecting the pH and BE value of fetal umbilical cord blood.

作者蒋卫清鲍红光高玉洁韩流徐丽

机构地区南京医科大学附属南京医院南京市第一医院麻醉科

出处《临床麻醉学杂志》 CAS CSCD 北大核心 2012年第10期964-967,共4页 Journal of Clinical Anesthesiology

关键词腰-硬联合麻醉心输出量剖宫产术 Combined spinal-epidural anaesthesia Cardiac output Cesarean section

分类号 R614 [医药卫生—麻醉学]

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参考文献10

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