不同输液负荷对硬膜外麻醉下剖宫产术产妇中心静脉压的影响

Effect of Different Fluid Loads on Maternal Central Venous Pressure during Epidural Anesthesia for Caesarean Delivery

目的探讨硬膜外麻醉下剖宫产术不同输液负荷对产妇中心静脉压(CVP)的影响。方法硬膜外麻醉下行剖宫产术产妇60例,按抽签法随机分为预负荷组(P组)和预负荷/共同负荷组(P/C组),每组30例。P组麻醉前以复方乳酸钠溶液10 ml/kg+6%羟乙基淀粉130/0.4(6%HES 130/0.4)溶液10 ml/kg快速输注;P/C组麻醉前以复方乳酸钠溶液10 ml/kg快速输注,硬膜外给药同时6%HES 130/0.4 10 ml/kg快速输注。记录输液负荷前后及硬膜外麻醉后CVP、SBP、HR和低血压发生率。结果 P组和P/C组产妇输入复方乳酸钠溶液和6%HES 130/0.4溶液后CVP均显著升高(P<0.05),P组高于P/C组(P<0.05)。两组产妇硬膜外麻醉后SBP、HR均低于麻醉前(P<0.05)。硬膜外麻醉后两组SBP值、HR及低血压发生率(分别为33.3%和26.6%)比较,差异均无统计学意义(P>0.05)。结论硬膜外麻醉剖宫产术产妇以10 ml/kg复方乳酸钠溶液预负荷联合6%HES130/0.4共同负荷可有效提升和保持产妇CVP水平,硬膜外麻醉后SBP及低血压发生率与预负荷无关。

Objective To observe the effect of different fluid load on maternal central venous pressure （CVP） for epidural anesthesia during caesarean section. Methods Sixty patients undergoing caesarean delivery under epidural anesthesia were randomly assigned to preload group （Group P, n = 30） and preload/coload group （Group P/C, n = 30）. In Group P,aU the patients received rapid infusion of compound solution of sodium lactate（10 ml/kg） and 6% hydroxyethyl starch 130/0.4 （10 ml/kg） before epidural anesthesia. In Group P/C, all the patients received rapid infusion of compound solution of sodium lactate（ 10 ml/kg） before epidural anesthesia, and rapid infusion of compound solution of 6% hydroxyethyl starch 130/0.4（10 ml/kg） were performed as epidural administration was conducted. CVP,SBP,HR and incidence of hypotension were recorded before and after infusion, and after epidural anesthesia. Results CVP of patients in two groups increased significantly after infusion of compound solution of sodium lactate and 6% hydroxyethyl starch 130/0.4（P 〈0.05） ,which in Group P was higher than that in Group P/C（P 〈0.05）. SBP,HR of patients in two groups after epidural anesthesia were significantly lower than those before anesthesia（P 〈 0.05）. There was no significant difference in SBP,HR and the incidence of hypotension（33.3% vs 26.6% ） after epidural anesthesia between two groups （P 〉 0.05 ）. Conclusion The preload/coload with compound solution of sodium lactate by 10 ml/kg and 6% hydroxyethyl starch 130/0.4 by 10 ml/kg for epidural anesthesia during caesarean section is efficient to improve and maintain maternal CVP level, SBP and the incidence of hypotension after epidural anesthesia don＇t correlate with fluid preload.