摘要
目的探讨妊娠合并心脏病患者围手术期不同容量管理方法对预防容量超负荷及术后并发症的影响。方法收集2014年6月至2019年6月北部战区总医院妇产科72例妊娠合并心脏病患者的临床资料,根据围手术期72h内平均每日液体负平衡量分组,A组(负平衡<500mL/d),B组(500mL/d≤负平衡<1000mL/d),C组(1000mL/d≤负平衡≤1500mL/d),比较各组患者血清氨基末端B型钠尿肽前体(NT-proBNP)、中心静脉压(CVP)、血清钾离子(K+)、红细胞压积(HCT)、术后血栓发生率的差异。结果3组患者接受治疗前一般临床资料(年龄、BMI、孕周、纽约心脏病协会心功能分级、妊娠风险分级、产科指征剖宫产率、心脏指征剖宫产率)比较,差异无统计学意义(P>0.05)。3组术后72h NT-proBNP数值和降低值,差异有统计学意义。A组术后72h NT-proBNP(158.92±114.64)ng/L,NT-proBNP降低值(67.96±32.36)ng/L;B组术后72h NT-proBNP(121.67±71.07)ng/L,NTproBNP降低值(191.08±81.22)ng/L;C组术后72h NT-proBNP(117.65±72.43)ng/L,NT-proBNP降低值(158.34±72.43)ng/L,(P<0.05),C组下降最明显。术后72h CVP,A组(9.13±0.24)cm H2O(1cm H2O=0.098kPa),B组(9.48±1.36)cm H2O,C组(8.57±0.82)cm H2O,C组与A组、B组比较,差异有统计学意义(P<0.05)。术后72h HCT,A组(0.3170±0.0092)%,B组(0.3573±0.0069)%,C组(0.3556±0.0072)%,C组与A组比较,差异有统计学意义(P<0.05)。3组患者术后均无容量不足、低血钾和血栓发生。结论妊娠合并心脏病剖宫产患者术后72h内平均每日液体负平衡维持在1000~1500mL,可能最有助于预防容量超负荷发生,并且未增加术后容量不足、低血钾及血栓等并发症的发生风险。
ObjectiveTo study the effects of different perioperative fluid management on preventing volume overloadand postoperative complications in pregnant women with heart disease.MethodsFrom June 2014 to June 2019,theclinical data of 72 pregnant women with heart disease in the Department of Obstetrics and Gynecology of GeneralHospital of the Northern Theater Command were collected and were divided into 3 groups according to the average dailyfluid negative balance within 72 hours during the perioperative stage:Group A(negative balance<500 m L/d),Group B(500 m L/d≤ negative balance<1000 m L/d)and Group C(1000 m L/d≤ negative balance≤ 1500 m L/d).The levels of serumNT pro-BNP,the changes of central venous pressure(CVP),K+,hematocrit and the incidence of thrombosis in eachgroup were compared in 72 h after operation.ResultsThere was no statistically significant difference in the generalclinical data(age, BMI, gestational age,NYHA class,classifification of maternal cardiovascular risk,cesarean section rate)among the three groups before treatment(P>0.05). There were significant differences in the levelof serum NT pro-BNP and the decrease of the level among 3 groups(P<0.05),and the largest decreased value at 72 hours after operation was found in group C.In Group A,NT-proBNP at 72 hours after operation was(158.92±114.64)ng/L,and the decreased value of NT-proBNP was(67.96 ±32.36)ng/L;in Group B,NT-pro BNP at 72 hours afteroperation was(121.67 ± 71.07) ng/L, and thedecreased value of NT-pro BNP was(191.08±81.22)ng/L;in Group C,NT-pro BNP at 72 hours after operation was(117.65±72.43)ng/L,and the decreased value of NT-pro BNPwas(158.34±72.43)ng/L(P<0.05).There were significant differences between group C and group A and B in CVP at 72 hours after operation(P<0.05).In Group A,CVP was(9.13±0.24)cm H2O(1 cm H2O=0.098 k Pa);in Group B,CVP was(9.48±1.36)cm H2O;in Group C,CVP was(8.57±0.82)cm H2O.There was significant difference between group C andgroup A in HCT at 72 hours after operation(P<0.05).In Group A,HCT was(0.3170±0.0092)%;in Group B,HCT was(0.3573±0.0069)%;in Group C,HCT was(0.3556±0.0072)%.Statistical data showed that no postoperative results ofhypovolemia or hypokalemia and thrombus occurred in the 3 groups after operation.ConclusionMaintaining anaverage daily negative fluid balance of 1000-1500 m L within 72 hours after operation may be more helpful to preventvolume overload in the pregnant women with heart disease undergoing cesarean section,without increasing the risk ofpostoperative complications such as hypokalemia,hypovolemia and thrombolism.
作者
葛静
单莉莉
安娜
刘鑫
王军
GE Jing;SHAN Li-li;AN Na;LIU Xin;WANG Jun(Departmerit of Obstetrics and Gynecology,General Hospital of the Northern Theater Command,Shenyang 110045,China)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2020年第2期159-162,共4页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家重点研发计划（2018YFC1002703,2018YFC1002700）
军委后勤保障部计生专项（19JSZ13）
关键词
心脏病
妊娠
剖宫产
容量管理
heart disease
pregnancy
caesarean section
fluid management
