腰-硬联合麻醉前胶体液或晶体液预充对产妇心输出量的影响

The effects of the colloidal or crystalloid preloading before combined spinal-epidural anesthesia on cardiac output in parturient

目的观察预充胶体液或晶体液对腰-硬联合麻醉下剖宫产产妇心输出量(CO)的影响。方法择期剖宫产手术患者45例,年龄20～30岁,随机均分为对照组(C组)、胶体液组(H组)、晶体液组(L组)。入室常规行NBP、ECG、SpO_2监测,均行左桡动脉穿刺置管连接Flotrac(经动脉压力波形分析)监测CO。建立静脉通路,C组不给任何预注,H、L组20min内以10ml/kg分别输入6%羟乙基淀粉注射液和复方乳酸钠后行麻醉穿刺。于液体预充前(T_0)、麻醉后3min(T_1)、5min(T_2)、10min(T_3)、20min(T_4)记录MAP、HR、CO。结果 T_1～T_4时C组MAP、CO明显低于H、L组,且L组低于H组(P<0.05)。T_1～T_4时三组MAP明显低于T_0时(P<0.05);H组CO高于,L组CO低于T_0时(P<0.05)。结论腰-硬联合麻醉前预充胶体液可使CO增加,预充晶体液可以避免CO降低,均可减轻剖宫产患者腰-硬联合麻醉后低血压程度。

Objective To observe and compare the effect of colloid or crystalloid solution preloading on cardiac output in combined spinal-epidural anesthesia during cesarean section. Methods Forty-five parturient, 20 to 30 years old, undergoing elective cesarean section were randomized into three groups with 15 each. Every parturient received routine NBP, ECG, SpO2 and cardiac output monitoring. The cardiac output was detected by left radial artery cannulation connecting to Flotrac monitor, group H or group L received hydroxyethyl starch or lactated Ringer＇s solution 10 ml/kg before anesthesia respectively. MAP, HR and CO were recorded at baseline（T0 ）, 3 min（T1 ）, 5 min（T2 ）, 10 min（T3 ） and 20 min（T4 ）after anesthesia. Results MAP and CA） were lower atT1 -T4 in group C than in groups H and L（P〈0. 05）. MAP and CO were lower in group L than in group H（P〈0. 05）. MAP was increased in all the groups at T1-T4. CO at T1-T4 was increased in group H but decreased in group L compared with To. Conclusion Preloading with colloid can increase cardiac output and preloading with crystalloid can avoid cardiac output decreasing in combined spinal-epidural anesthesia in cesarean section. Both methods can relieve hypotension after anesthesia,