摘要
目的观察剖宫产术麻醉前静脉预注羟乙基淀粉130/0.4电解质注射液与羟乙基淀粉130/0.4氯化钠注射液对产妇血浆胶体渗透压、电解质浓度及胎儿氧利用度的影响。方法ASAⅠ~Ⅱ级足月单胎择期腰-硬联合麻醉下行剖宫产产妇60例,随机分为羟乙基淀粉130/0.4电解质注射液组(A组)、羟乙基淀粉130/0.4氯化钠注射液组(B组)和乳酸钠林格注射液组(C组),每组20例。剖宫产术麻醉前,A组预注500 mL羟乙基淀粉130/0.4电解质注射液,B组预注500 mL羟乙基淀粉130/0.4氯化钠注射液,C组预注500 mL乳酸钠林格注射液,然后进行腰-硬联合麻醉。分别于输液前(T1)及术毕(T2)抽取产妇静脉血,采用血浆胶体渗透压测量仪测量产妇血浆胶体渗透压,采用血气分析仪测定产妇静脉血K^+、Na^+、Cl^-、Ca^(2+)、Mg^(2+)等电解质浓度。胎儿娩出断脐后立即抽取脐动脉及脐静脉血,采用血气分析仪测定胎儿脐静脉氧分压(PvO2)、脐动脉氧分压(PaO2)、脐静脉氧饱和度(SvO2)、脐动脉氧饱和度(SaO2),计算胎儿脐动静脉血氧分压差(P(a-v)O2)和氧饱和度差(S(a-v)O2)等氧利用度指标。观察并记录三组产妇术中最高麻醉平面(胸段)、输液量、出血量、尿量、低血压发生率、恶心呕吐发生率、去氧肾上腺素使用总量等术中情况。结果A、B、C组产妇T1时血浆胶体渗透压分别为(19.0±1.9)、(19.2±1.2)、(18.4±3.0)mmHg,组间相比,P均>0.05;A、B、C组产妇T2时血浆胶体渗透压分别为(18.9±1.7)、(18.8±1.6)、(16.9±2.3)mmHg,A、B组与C组相比,P均<0.05。A、B、C组产妇同一时点电解质浓度差异无统计学意义(P均>0.05)。A组胎儿P(a-v)O2、S(a-v)O2分别为29.8%±15.3%、(12.8±6.6)mmHg,B组分别为28.9%±12.4%、(12.1±5.0)mmHg,C组分别为26.0%±11.4%、(10.6±5.3)mmHg,A、B组与C组相比,P均<0.05。A、B、C组产妇最高麻醉平面(胸段)、输液量、出血量、尿量、低血压发生率、恶心呕吐发生率、去氧肾上腺素使用总量等术中情况差异无统计学意义(P均>0.05)。结论与预注乳酸钠林格注射液相比,羟乙基淀粉130/0.4电解质注射液与羟乙基淀粉130/0.4氯化钠注射液剖宫产术麻醉前静脉预注产妇的血浆胶体渗透压下降程度低、电解质浓度稳定、胎儿氧利用度高。
Objective To observe the effects of hydroxyethyl starch 130/0.4 electrolyte injection and hydroxyethyl starch 130/0.4 sodium chloride injection preloading on maternal plasma colloid osmotic pressure and electrolytes and fetal oxygen utilization in caesarean section.Methods Sixty maternal(ASAI-II)single full-term pregnant women scheduled for elective cesarean delivery under combined spinal and epidural anesthesia(CSEA)were randomly divided into three groups to receive hydroxyethyl starch 130/0.4 balanced electrolyte injection(group A),hydroxyethyl starch 130/0.4 sodi um chloride injection(group B),and lactate Ringer's injection(group C),with 20 in each group.Before anesthesia,pregnant women in the group A were treatecl with 500 mL of hydroxyethyl starch 130/0.4 electrolyte injection,group B with 500 mL of hydroxyethyl starch 130/0.4 sodium chloride injection,and group C with 500 mL of sodium lactate Ringer's injection,followed by combined spinal and epidural anesthesia.Maternal venous blood was collected before infusion(T1)and after surgery(T2).Plasma colloid osmotic pressure measuring instrument was used to measure maternal plasma colloid osmotic pressure.Blood gas analyzer was used to measure maternal venous blood K+,Na+,Cl-,Ca2+and Mg2+.Umbilical artery and venous blood were collected immediately after the fetus was delivered.The blood gas analyzer was used to measure the partial pressure of umbilical venous oxygen(PvO2),partial pressure of umbilical artery(PaO2),umbilical venous oxygen saturation(SvO?)and umbilical artery oxygen saturation(SaO?).We calculated the oxygen utilization index of fetal umbilical arteriovenous blood oxygen pressure difference(Pa-V O?)and oxygen saturation difference(Pa-V O?),recorded the highest block level(thoracic segment),infusion volume,bleeding volume,urine volume,incidence of hypotension,nausea and vomiting and total phenylephrine use during operation.Results Plasma colloid osmotic pressure in the groups A,B,and C was(19.0±1.9),(19.2±1.2),and(18.4±3.0)mmHg at T1;at T2,the plasma colloid osmotic pressure of groups A,B,and C was(18.9±1.7),(18.8±1.6),and(16.9±2.3)mmHg,respectively.Compared with group C,significant difference was found(P<0.05).There were no significant differences in electrolyte concentration at the same time among groups A,B and C(P>0.05).The fetal Pa-v°2 and Pa-v°2 in the group A were 29.8%±15.3%and(12.8±6.6)mmHg,those in the group B were 28.9%±12.4%and(12.1±5.0)mmHg,and 26.0%±11.4%and(10.6±5.3)mmHg in the group C,with significant difference(all P<0.05).There were no significant differences in the highest block level(thoracic segment),infusion volume,bleeding volume,urine volume,incidence of hypotension,incidence of nausea and vomiting,or total phenylephrine use between the groups A,B,and C.(P>0.05).Conclusion Compared with lactate Ringer's injection,hydroxyethyl starch 130/0.4 electrolyte injection and hydroxyethyl starch 130/0.4 sodium chloride injection intravenous preloading may reduce the decrease of maternal plasma colloid osmotic pressure,and maternal electrolyte concentrations are stabler,with higher fetal oxygen utilization.
作者
邹璐雯
徐铭军
王天龙
ZOU Luwen;XU Mingjun;WANG Tianlong(Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
出处
《山东医药》
CAS
2019年第36期5-8,共4页
Shandong Medical Journal
