不同液体扩容对剖宫产脊髓麻醉后低血压防治效果的比较

Different Fluid Expansion for the Prevention of Spinal Hypotension in Cesarean Section

目的探讨不同液体扩容对剖宫产脊髓麻醉后低血压防治效果的影响。方法选择择期脊髓麻醉下行剖宫产手术病人60例,随机分为四组(n=15),组:麻醉前10 min开始匀速输注复方氯化钠(LR),100滴/min;组、组、组于麻醉即刻分别快速输注复方氯化钠、聚明胶肽、羟乙基淀粉,容量均为10 ml/kg。测量各时点血压变化并记录。结果脊髓麻醉后15 min内,组、组、组与组相比平均动脉压差异有统计学意义(P<0.05);组、组、组间比较平均动脉压差异无统计学意义(P>0.05)。麻醉后20 min,组、组与组相比平均动脉压差异有统计学意义(P<0.05)。组与组,组与组相比平均动脉压差异无统计学意义(P>0.05)。结论麻醉即刻扩容,晶体液和胶体液均可改善脊髓麻醉前期低血压状态,后期胶体液可能更佳。

Objective To investigate the different fluid expansion therapeutic effect to the hypotension induced by spinal anesthesia.Methods A total of 60 patients who would accept cesarean section under spinal anesthesia were selected and randomly divided into four groups： Group Ⅰ received continuous infusion of 0.9 % sodium chloride solution at the rate of iv100gtt;Group Ⅱ,Ⅲ and Ⅳ were respectively received rapid infusion of sodium chloride solution,polygeline,hetastarch at the point of bupivacaine injected,the capacity were all 10 ml/kg.The BP were recorded.Results In the preceding 15 min after spinal anesthesia,the mean arterial pressure（MAP） was lower in Group Ⅰcompared to Group Ⅱ,Ⅲ and Ⅳ（P〈0.05）;but there was no statistical difference within Group Ⅱ,Ⅲ and Ⅳ（P〉0.05）.Twenty minutes after anesthesia,the MAP in Group Ⅲ and Ⅳ was higher than in Group Ⅰ and Ⅱ（P〈0.05）,there was also no statistical difference between Group Ⅲ and Ⅳ or Group Ⅰ and Ⅱ（P〈0.05）.Conclusion In the immediate expansion after anesthesia,crystalloid and colloid solution may improve pre-spinal anesthesia hypotension,colloid may be better in later period.