麻醉前扩容对腰硬联合麻醉产科手术血压的影响

Effect of capacity expansion on blood pressure in obstetric operation before combined spinal-epidural anesthesia

目的:探讨麻醉前扩容对腰硬联合麻醉产科手术血压的影响。方法:选择150例择期剖宫产手术产妇,随机分为3组,每组50例。A组麻醉前不扩容,麻醉后以6～8 ml/kg.h输入乳酸林格氏液。B组麻醉前30 min输入乳酸林格氏液500 ml,麻醉后以6～8 ml/kg.h继续输入乳酸林格氏液。C组麻醉前30 min输入羟乙基淀粉500 ml,麻醉后以6～8 ml/kg.h继续输入乳酸林格氏液。记录3组产妇麻醉后低血压发生率及麻黄素使用率。结果:A组、B组和C组患者麻醉后血压下降的发生率分别为54%、28%和12%,三组低血压发生率差异有统计学意义。B组和C组低血压发生率低于A组(P<0.01)。C组低血压发生率低于B组(P<0.05)。A组麻黄素使用率高于B组和C组(P<0.01)。结论:腰硬联合麻醉前扩容可有效预防麻醉后低血压的发生,羟乙基淀粉扩容效果要优于乳酸林格氏液。

Objective： To observe effect of capacity expansion on blood pressure in obstetric operation before combined spinal-epidural anesthesia.Methods： 150 cases of elective cesarean section operation maternal were randomly divided into three groups,50 cases in each group.A group was not expanded before anesthesia and was input 500 ml Lactated Ringer＇s solution with 6~8 ml/kg·h after anesthesia.Group B was input 500 ml Lactated Ringer＇s solution in 30 minutes before anesthesia,then was input Lactated Ringer＇s solution with 6~8 ml/kg·h after anesthesia continuously.Group C was input 500 ml Hydroxyethyl starch in 30 minutes before anesthesia,then was input Lactated Ringer＇s solution with 6~8 ml/kg·h after anesthesia continuously.The incidence of hypotension and Ephedrine use rate were recorded in the three groups.Results： The incidence rate of blood pressure decrease in group A patients,B patients and C patients after anesthesia was respectively 54%,28%,12%.There were significant differences about the incidence rate of blood pressure decrease in the three groups.The incidence of hypotension in B group and C group was lower than that in group A（P0.01）.The incidence of hypotension in C group was lower than that in group B（P0.05）.Ephedrine use rate of group A was higher than that in group B and group C（P0.01）.Conclusion： Capacity expansion before combined spinal-epidural anesthesia can effectively prevent the occurrence of hypotension after anesthesia.Hydroxyethyl starch expansion was superior to Lactated Ringer＇s solution.