BioZ.com监测腰-硬联合麻醉下剖宫产产妇的血流动力学变化

Hemodynamic changes in puerperas undergoing elective cesarean section with combined spinal and epidural anesthesia via the BioZ.com system

目的:应用无创血流动力学监测仪BioZ.com,探讨腰-硬联合麻醉下剖宫产围术期产妇血流动力学变化。方法:19例择期在腰-硬联合麻醉下行剖宫产的产妇,ASAⅠ～Ⅱ级,连接BioZ.com连续监测血流动力学变化,分别在麻醉前,麻醉后5、15min,胎儿娩出前1min,胎儿娩出后3min,术毕时记录心率(HR)、每搏输出量(SV)、平均动脉压(MAP)、心排量(CO)、心脏指数(CI)、体循环阻力(SVR)、胸腔液体量(TFC)、左室射血时间(LVET)。结果:围术期各时点HR、TFC、LEVT无明显变化(P>0.05);麻醉后15minSVR开始下降,术毕时仍显著低于麻醉前(P<0.01),SV、CO、CI在麻醉后15min开始升高(P<0.05);MAP除在术毕时显著低于术前(P<0.01)外,其他时间点的差异无统计学意义。胎儿娩出前后相比,胎儿娩出后产妇的HR、MAP基本维持稳定,而SV、CO、CI明显升高,SVR则明显下降(P<0.05);SV、CO、CI与SVR呈负相关(P<0.01),MAP与SVR呈正相关(P<0.01)。结论:应用BioZ.com监测剖宫产围术期产妇的血流动力学变化,可为围术期的处理提供更多可靠的依据。

Objective To observe the hemodynamic changes by the BioZ.com noninvasive hemodynamic monitoring system in puerperas undergoing cesarean section with combined spinal and epidural anesthesia. Methods The hemodynamic changes were consecutively monitored by the BioZ.com system in 19 ASA Ⅰ or Ⅱ puerperas undergoing elective cesarean section with combined spinal and epidural anesthesia. Hemodynamic parameters including mean arterial pressure （MAP）, heart rate （HR）, stroke volume （SV）, cardiac output （CO）, cardiac index （CI）, systemic vascular resistance （SVR）, thoracic fluid content （TFC）, and left ventricular ejection time （LVET） were recorded before and 5 and 15 minutes after anesthesia, 1 minute before and 3 minutes after cesarean delivery, and completion of the procedure. Results No significant changes in HR, TFC, and LEVT occurred at different time points （P 〉 0.05）. SVR began to decrease 15 minutes after anesthesia and maintained at a low level when the procedure was completed（P 〈 0.01）. SV,CO and CI began to increased 15 minutes after anesthesia （P 〈 0.05）. MAP was markedly lower at completion of the surgery （P 〈 0.01 ）. HR and MAP remained stable while SV, CO and CI were obviously elevated but SVR was evidently declined （P 〈 0.05）. SVR was negatively related with SV, CO and CI （P 〈 0.01） but positively with MAP （P 〈 0.01 ）. Conclusion Application of the BioZ.com system to monitor the hemodynamic changes in puerperas undergoing cesarean section provides more reliable evidence for the perioperative management.