重度子痫前期剖宫产产妇围术期液体治疗后的血液动力学变化

Hemodynamic change of severe preeclampsia maternal with cesarean section after fluid therapy in perioperative period

目的研究重度子痫前期剖宫产产妇围术期中心静脉压(CVP)和动脉血压监测(ART)等血液动力学的变化,探讨围术期液体治疗的合理性和安全性。方法选择重度子痫前期择期行剖宫产术的产妇40例,将其分为晶体组和胶体组,每组各20例,麻醉前给予晶体组乳酸林格液,给予胶体组6%羟乙基淀粉酶,均给予麻醉下行剖宫产术,监测麻醉前后两组患者的CVP值、ART及生命体征。结果麻醉前,两组的CVP与麻醉后5、10 min时相比,差异均有统计学意义(均P<0.05);麻醉后10 min,胶体组CVP高于晶体组[(4.7±0.5)mm Hg比(5.3±0.5)mm Hg](P<0.05);胶体组的ART高于晶体组[(115.0±13.5)mm Hg比(100.0±10.8)mm Hg,P<0.05]。结论重度子痫前期剖宫产妇围术期,容量负荷的变化主要是麻醉后至胎儿娩出前,围术期液体治疗可以保障术中循环稳定,胶体液的应用是安全有效的,可适当应用于子痫前期患者,对围术期容量负荷的影响不大,对维持重度子痫前期患者围术期循环稳定有积极作用。

Objective To study the hemodynamic changes of central venous pressure （CVP） and arterial blood pressure monitoring （ART） of severe preeclampsia maternal with cesarean section,in order to explore the rationality and security of perioperative fluid therapy.Methods 40 cases with severe preeclampsia maternal elective surgical procedures were selected and divided into crystals group and colloidal group,with 20 cases in each group,crystal group was given the Ringer solution,colloid group was given the 6% hydroxyethyl amylase,both groups were given the cesarean section,the CVP and ART of two groups before and after anesthesia were monitored.Results The CVP of two groups before anesthesia was higher than those of 5 and 10 min after anesthesia,the difference was statistically significant （P 〈 0.05）; 10 minutes after anesthesia,the CVP of colloid group was higher than that of crystals group [（4.7±0.5） mm Hg vs （5.3±0.5） mm Hg] （P 〈 0.05）; the ART of colloid group was higher than that of crystals group [（115.0±13.5） mm Hg vs （100.0±10.8） mm Hg] （P 〈 0.05）.Conclusion Severe preeclampsia maternal with cesarean section in perioperative period,the change of the volume load is mainly occur before the fetal childbirth and after the nesthesia; perioperative fluid therapy can guarantee the cycle stability,and the application of colloid is safe and effective,may be appropriately applied in the patients with preeclampsia,less influence on the perioperative load capacity,playing a positive role in the circulatory stability of patients with severe preeclampsia maternal in perioperative period.