羟乙基淀粉预扩容对腰麻剖宫产母体循环功能影响的研究

Study of effect of colloidal Liquid pre-expansion on circulation in parturient undergoing caesarean seotion

目的观察羟乙基淀粉和乳酸钠林格氏液预扩容对剖宫产妇腰-硬联合麻醉后循环功能的影响。方法择期剖宫产妇120例,随机分为两组,每组60例,麻醉前分别输入分子量130000羟乙基淀粉（130/0.4）氯化钠注射液（Ⅰ组）和乳酸林格氏液（Ⅱ组）。左侧卧位,L3～4间隙穿刺,见脑脊液后,注入含糖0.75%罗哌卡因10mg立即改平卧,手术床面左倾15°,鼻导管吸氧4ml/min,控制麻醉平面于T6以下。于麻醉前、麻醉3、5、10min记录收缩压（SBP）、舒张压（DBP）、HR、SpO2。结果I组麻醉后3、5、10min各时点SBP、DBP也较术前下降（P〈0.01）,但术毕时SBP、DBP与术前比较差异无显著性意义（P〉0.05）;II组产妇麻醉后3、5、10min、术毕各时点SBP、DBP仍低于麻醉前（P〈0.01）。组间比较,I组麻醉后3、5、10min、术毕时SBP、DBP均高于Ⅱ组（P〈0.05）。两组产妇麻醉后心率各时点与术前比较差异无显著性,组间比较差异无显著性（P〉0.05）。结论羟乙基淀粉预扩容可有效预防剖宫产妇腰麻后血压下降,有利于维持循环功能稳定。

Objective To study the differential effect of pre-fluid expansion with hydroxyethly starch （HES） colloidal liquid and sodium lactate Ringer＇s solution on circulation in parturient of caesarean section. Methods 120 parturient of caesarean section were divided randomly to hydroxyethyl starch group （ Ⅰ ） and Lactated Ringer＇s Solution group （ Ⅱ ）. Parturient were left recumbent position, lumbar puncture in intervertebral space between 3 and 4. After seeing cerebrospinal fluid, they were injected 10 mg 0.75% ropivacaine sugar solution, and then turned to prostration. Operation table was left-leaned 15 degree angle to reduce supine hypotension syndrome and providing oxygen by nasal catheter 4ml / min, controlling narcotic plane under T6. systolic blood pressure （SBP）, diastolic blood pressure （DBP）, HR, SpO2 were recorded in the time of pre-anesthesia, 3 rain, 5 min and10 min after anesthesia, Result After anesthesia, SBP and DBP of group Ⅰ decreased at 3 rain, 5 min and 10 rain compared with that of pre-operation （P〈 0.01）, but no significant differences with that of post-operation; SBP, DBP of group Ⅱ at 3 min, 5 min and 10min after anesthesia deceased compare with that of pre-operation （P〈0.01）. SBP, DBP of group Ⅰ at 3 min, 5 min and 10 min after anesthesia and post-operatiion were significantly higher than those of group H （P〈0.05）. The heart rates of two groups were no significant difference（P〉0.05） in every point of time and there were significant difference between the groups（P〈 0.05）. Conclusion The application of pre-expansion using colloidal liquid hydroxyethyl starch for the patients undergoing cesarean section can contribute to the maintenance of circulation stability after lumbar anesthesia.