剖宫产产妇椎管内麻醉低血压发生危险因素分析及预防对策

Risk factors analysis and the preventive measures of the hypotension during spinal anesthesia of cesarean section

目的:分析剖宫产产妇椎管内麻醉后的低血压发生率及危险因素,提出预防对策。方法:收集2021年8月-2023年8月在本院产科收治的100例椎管内麻醉下剖宫产产妇临床资料,统计产妇麻醉后的低血压发生率。根据是否发生低血压将产妇分为低血压组与非低血压组,比较两组相关资料的差异性;运用logistic分析低血压发生的危险因素。受试者工作特征曲线(ROC)预测低血压发生的效能。结果:100例产妇中发生低血压40例,发生率为40.0%。低血压组40例、非低血压组60例;两组孕前体质指数(BMI)、宫高、脑电双频指数(BIS)、下腔静脉塌陷指数(CI)、高尿酸血症、术前心率、使用双下肢弹力绷带比较有差异(P<0.05),两组年龄、分娩前BMI、分娩孕周、分娩经历、瘢痕子宫、ASA分级、禁食时间、麻醉前输液量、巨大儿、羊水过多、胎位方向、贫血、低蛋白血症、电解质紊乱、术前收缩压比较未见差异(P>0.05)。logistic分析显示,孕前BMI大、宫高高、BIS降低、CI升高、术前心率升高是低血压发生的危险因素,高尿酸血症、使用双下肢弹力绷带是低血压的保护因素(P<0.05)。ROC分析,预测低血压发生的曲线下面积为0.932(95%CI 0.897~0.967),预测敏感度为78.2%,特异度为93.5%。结论:剖宫产产妇椎管内麻醉后的低血压发生率较高,危险因素较多,应积极采取预防与干预措施,以提高手术安全性。

Objective:To analyze the incidence and the risk factors of the hypotension during spinal anesthesia of cesarean section of women,and to provide the preventive measures.Methods:The clinical data of 100women with cesarean section under spinal anesthesia who had admitted to the obstetrics department of the hospital from August 2021 to August 2023 were collected,and the incidence of the hypotension of the women after anesthesia was counted.These women were divided into group A(women with hypotension)and group B(women without hypotension)based on whether the hypotension occurrence or not,and the differences of the relevant information of the women were compare between the two groups.Logistic analysis was used to analyze the risk factors of the hypotension occurrence of the women.The predictive efficiency for the hypotension occurrence of the women was evaluated by receiver operating characteristic(ROC)curve.Results:The incidence of the hypotension of the women was 40.0%(40/100).There were 40women in group A and 60women in group B.There were significant differences in the body mass index(BMI),the uterine height,the values of bispectral index(BIS)and inferior vena cava collapse index(CI),the hyperuricemia rate,the preoperative heart rate,and the proportion of the elastic bandages used in both lower limbs of the women between the two groups(P<0.05).There were no significant differences in the age,the BMI before delivery,the gestational weeks at delivery,the delivery history,the scarred uterus proportion,the ASA grade,the fasting time,the infusion volume before anesthesia,the rates of macrosomia,polyhydramnios,fetal position direction,anemia,hypoproteinemia and electrolyte disturbance,and the preoperative systolic blood pressure values of the women between the two groups(P>0.05).Logistic analysis showed that higher pre-pregnancy BMI,the higher uterine height,the decrease of the BIS value,the higher CI value and the higher preoperative heart rate of the women were the risk factors of their hypotension occurrence,while the hyperuricemia and lower limb elastic bandages used of the women were the protective factors of their hypotension occurrence(P<0.05),and ROC analysis showed that the area under the curve,the sensitivity and the specificity of the combination of which for predicting the hypotension occurrence of the women were 0.932(95%CI 0.897-0.967),78.2% and 93.5%,respectively.Conclusion:The incidence of the hypotension after the spinal anesthesia during cesarean section of the women is relatively higher,and there are many risk factors of the hypotension occurrence of the women.The prevention and intervention measures should be actively taken to improve the surgical safety of the women during the cesarean section.