子痫前期孕妇剖宫术腰硬联合麻醉期间血流动力学和血浆一氧化氮变化

Changes of hemodynamics and plasma nitric oxide concentration during combined spinal-epidural anesthesia for cesareansection in patients with preeclampsia

目的观察子痫前期孕妇剖宫术腰顿联合麻醉（combinedspinalepiduralanaesthesia，CSE）期间血流动力学及血浆一氧化氮（nitricoxide，NO）和肿瘤坏死因子-α（tumornecrosisfactor-α，TNF-α）的变化。方法选择孕（36周＋3）～40周拟行剖宫术健康足月（n=25）和严重子痫前期（n=24）孕妇，行CSE（O．75％重比重布比卡因10mg-12mg），控制感觉消失目标平面在T6-8水平，观察麻醉期间对孕妇血流动力学、血浆，NO和TNF咀，新生儿体重和Apgar评分等的变化。结果脊麻后两组孕妇最低收缩压、舒张压和平均动脉压均较组内基础值明显降低（P〈0．05），但其下降的程度两组相仿；两组脊麻后低血压发生率、麻黄碱使用率和用量以及新生儿体重、Apgar评分差异均无统计学意义；子痫前期组血浆NO水平[（732±213）mmol／L]显著低于健康足月组[（3473±231）mmol／L]（P〈O．01），而子痫前期组TNF咀[（2103±371）ng／L]明显高于健康足月组[（1321±325）ng/L]（P〈O．01）。结论子痫前期孕妇剖宫术选择CSE是安全、可行的，炎症因子TNF啾释放增加和血管舒张因子NO合成减少可能是子痫前期血压升高的双重因素。

Objective To observe the change of hemodynamics, plasma concentration of nitric oxide （NO） and tumor necrosis factor-alpha （TNF-α） during combined spinal -epidural anesthesia （CSE） for cesarean section in preeclamptic patients. Methods Forty-nine pregnant women, 25 healthy women at （36 weeks＋3） -40 weeks＇ gestation and 24 women with severe preeclampsia, were scheduled for elective cesarean section （n=24）. All patients were underwent CSEA with 0.75% hyperbaric bupivaeaine at dose range of 10 mg-12 mg, and the sensory block height was controlled at T6-8. Changes of hemodynamic parameters, plasma cor,centration of NO and TNF-α of the puerperas,body weight and Apgar score of the neonates were observed during anesthesia. Results There was significant decrease in the lowest systolic pressure, diastolic pressure and mean arterial pressure of all patients after spinal anesthesia compared with their basic level （P〈0.05）, and the decreasing extent was similar between the two groups. There was no difference in incidence of hypotension, the total dose of ephedrine, neonates＇ body weight and Apgar score between the two groups. The concentration of plasma NO in preeclampsia group [ （732±213） mmol/L] was significantly lower than that in healthy group [ （3 473±231 ） mmol/L,P〈0.01 ], and the level of plasma TNF-α in preeclampsia group [ （2 103±371） ng/L] was significantly higher than that in healthy group [（1 321 ±325） ng/L,P〈0.01]. Conclusions Combined spinal-epidural anesthesia is feasible for cesarean section. Increasing of TNF-α release and decreasing of NO synthesis may be the reduplicative factors which lead to the hypertension of preeclamptic patients