羟乙基淀粉应用于腰硬联合麻醉下剖宫产术的临床观察

THE CLINICAL EFFECT OF USING HYDROXYETHYL STARCH FOR CAESAREAN SECTION UNDER COMBINED SPINAL-EPIDURAL ANESTHESIA

目的探讨容量治疗对剖宫产产妇血流动力学及凝血功能的影响。方法将100例行剖宫产手术的患者随机分为观察组与对照组,各50例,于麻醉前观察组输入6%羟乙基淀粉注射液和对照组输入乳酸钠林格氏液各500ml预扩容,分别记录并比较输液前(T0)、输液后(T1)、腰麻后1min(T2)、5min(T3)和10min(T4)时患者BP、HR、SPO2、ECG,以及输液前、后血红蛋白(HB)、红细胞压积(HCT)、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)和纤维蛋白原(FIB)变化。结果观察组产妇血压下降不明显,与对照组比较差异有统计学意义,且恶心、呕吐等发生率明显低于对照组(P<0.05)。输液后血红蛋白含量、红细胞压积均降低、血小板计数、凝血酶原时间等其他指标变化,组间比较均无统计学意义(P>0.05)。结论腰麻前预输入6%羟乙基淀粉130/0.4氯化钠注射液较乳酸钠林格氏液更有效扩充血容量,维持循环功能的稳定,且对凝血系统无明显影响。

ObjectiveTo explore the clinical effect of volume therapy on the hemodynamics and the coag- ulation function in cesarean section. Methods 100 cases of cesarean section were randomly divided into the observation group and the contrast group with 50 cases in each group. The observation group was injected with 500ml of 6 % hydroxyethyl s^rch and the contrast group was injected with 500ml of Lactated Ringer ＇s solution. The changes in BP, HR, SPO2 and ECG before transfusion, after transfusion, one minute af- ter lumbar anesthesia, five minutes dfter lumbar anesthesia, ten minutes after lumbar anesthesia, and the HB before and after transfusion, HCT, PLT, PT, APTT and profibrin were recorded. Results The blood pressure in lying-in women did not decrease obviously in the observaiion group and there existed significant difference between the two group, and the incidences of nausea and yomiting decreased more obviously in the observation group than in the contrast group（ P 〈（0.05）. No significant difference was found betweenthe groups in terms of the decrease in the content of hemoglobin and volume of packed red cells, the blood platelets counts, the prothrombin time（P 〉0. 05）. Conclusion Injection of 6 hydroxyethyl starch before lumbar anesthesia in 130/0.4 normal saline infusion canhave better effect on expanding blood volume in cesarean sections than Lactated Ringer＇s solution and main- taining circulatory functions without having obvious effect on coagulation system.