剖宫产术中低血压的原因和处理

Causes and Treatment of Hypotension during Caesarean Section

椎管内神经阻滞下剖宫产手术中低血压是最常见的并发症。发生低血压时的处理包括改变子宫位置、下肢加压促使静脉血回流、预先静脉输液及血管活性药物的应用等。发生仰卧位低血压综合征时普遍采取使子宫左偏,下肢加压有效但是应用并不普遍。静脉内输入大量晶体液升压效果也不明显,输注胶体液有效但是价格昂贵而且有潜在的并发症。血管活性药物如麻黄素不减少子宫的血流,去氧肾上腺素抗低血压效果好,浓度容易滴定,而且对胎儿的血液pH值和碱剩余影响较小。

Hypotension is the most common complication of regional anaesthesia for caesarean section. Methods managing hypotension include changing the postion of uterus, promoting the venous return by forcing the lower limbs,intravenous transfusion in advance and using vasoactive agents. Displacing uterus to the left and forcing the lower limbs are the effective methods commonly used in supine hypotensive syndrome, but its application is not vey popular. Intravenous transfusion of quantity of crystalloid liquids can not achieve good outcome in increasing blood pressure, intravenous tansfusion of colloids is more effective, while it is vey expensive and has potential complications. Among all vasoactive agents,Ephedrine does not reduce the flow of uterus, phenylephrine has good efficacy in anti-hypotension and less influence on the PH and base excess （BE） of fetal blood, Besides that,its titre is easily detected.