妊娠高血压综合征患者腰硬联合麻醉中不同体位选择及血流动力学状况分析

Analysis of different posture selection and hemodynamic status in patients with pregnancy-induced hypertension syndrome combined with lumbar and hard anesthesia

目的:探讨妊娠高血压综合征(PIH)患者腰硬联合麻醉中不同体位选择及血流动力学状况,为患者的临床麻醉提供相关指导。方法:选取2018年10月~2020年1月我院接收诊治的需行腰硬联合麻醉的129例PIH患者为研究对象。按照随机数字表法,将所有患者分为A、B、C三组,各43例。A组患者取仰卧位,B组患者取左侧倾斜30°位,C组患者取左侧倾斜30°结合头低足高位。对比三组患者的麻醉效果、手术相关指标、不同时间点[麻醉前(T_(0))、麻醉1min后(T_(1))、麻醉5min后(T_(2))、麻醉10min后(T_(3))]心输出量(CO)、心率(HR)、舒张压(DBP)、收缩压(SBP)等血流动力学指标,并分析三组患者麻醉不良反应情况。结果:B组、C组患者的麻醉优良率分别为97.67%、93.02%,均明显高于A组的76.74%;C组患者手术时间、术中出血量及胎头娩出时间分别为[(35.72±5.20)min、(194.42±28.36)mL、(1.10±0.15)min],均明显短(少)于B组和A组的[(54.34±7.34)min、(231.35±32.34)mL、(2.64±0.28)min]、[(65.68±9.73)min、(244.02±35.46)mL、(2.86±0.33)mL],差异有统计学意义;三组患者T_(0)的CO、HR、DBP及SBP等血流动力学指标相比,差异无统计学意义;C组患者T_(1)、T_(2)、T_(3)的CO指标均明显高于A组和B组,C组患者T_(1)、T_(2)、T_(3)的HR、DBP及SBP指标均明显低于A组和B组;B组、C组患者的麻醉不良反应发生率分别为4.65%、6.98%,均明显低于A组的23.26%。结论:PIH患者腰硬联合麻醉中采取左侧倾斜30°结合头低足高位的效果更好,提高麻醉优良率的同时,促进患者手术相关指标及血流动力学状况明显改善,且有效减少其麻醉不良反应,值得临床广泛应用。

Objective To investigate the different posture options and hemodynamic status of combined lumbar and hard anesthesia in patients with pregnancy-induced hypertension syndrome(PIH),and to provide relevant guidance for the patients’clinical anesthesia.Methods A total of 129 patients with PIH who were treated in our hospital from October 2018 to January 2020 and required combined lumbar and epidural anesthesia were selected as the study objects.According to the random number table method,all the patients were divided into groups A,B and C,with 43 patients in each.Patients in group A were placed in supine position,patients in group B were placed in the left oblique position of 30°,and patients in group C were placed in the left oblique position of 30°with low head and high foot.The anesthesia effect,surgery related indicators,and hemodynamic indicators such as cardiac output(CO),heart rate(HR),diastolic blood pressure(DBP),systolic blood pressure(SBP)at different time points[before anesthesia(T_(0)),1min after anesthesia(T_(1)),5min after anesthesia(T_(2)),10min after anesthesia(T_(3))]of the three groups were compared,and the adverse reactions of anesthesia in the three groups of patients were analyzed.Results The excellent and good rates of anesthesia in group B and group C were 97.67%and 93.02%,which were significantly higher than 76.74%in group A;the operative time,intraoperative blood loss and fetal head delivery time of group C were[(35.72±5.20)min,(194.42±28.36)mL,(1.10±0.15)min],which were significantly shorter(less)than those of group B and group A[(54.34±7.34)min,(231.35±32.34)mL,(2.64±0.28)min],[(65.68±9.73)min,(244.02±35.46)ml,(2.86±0.33)mL],the difference was statistically significant;the CO indexes of T_(1),T_(2)and T_(3)in group C were significantly higher than those in group A and group B,and the HR,DBP and SBP indexes of T_(1),T_(2)and T_(3)in group C were significantly lower than those in group A and group B;the incidence of anaesthesia adverse reactions in group B and group C was 4.65%and 6.98%,which were significantly lower than 23.26%in group A.Conclusion In the combined lumbar and epidural anesthesia of PIH patients,the left side tilt of 30°combined with the high head and foot is better,while improving the rate of good and good anesthesia,it also promotes the obvious improvement of surgical indicators and hemodynamic status of the patients,and effectively reduces their adverse reactions to anesthesia,which is worthy of clinical application.