麻醉前预扩容在硬膜外麻醉下剖宫产的应用研究

Applied Research of Cesarean Section in Pre-expansion before the Treatment of Anaesthesia Under Epidural Anesthesia

目的:临床观察硬膜外麻醉下剖宫产麻醉前液体扩容的临床效果。方法:选择硬膜外麻醉下择期单胎剖宫产的足月产妇共90例,随机分为3组(n=30),A组为麻醉前静脉输注6%羟乙基淀粉130/0.4氯化钠注射液组;B组为麻醉前静脉输注乳酸钠林格液组,C组为不用麻醉前预扩容组,每组各30例。3组均无术前用药。观察3组产妇麻醉后收缩压(SBP)、舒张压(DBP)、心率(HR)的变化,及新生儿Apgar评分,发生恶心呕吐及麻黄素的使用等情况。结果:A、B两组麻醉后低血压的发生率、麻黄素的使用均低于C组,差异有统计学意义(P<0.05),且A组血流动力学较B组更稳定。新生儿Apgar评分3组间差异无统计学意义(P>0.05)。结论:在硬膜外麻醉下剖宫产麻醉前使用液体扩容能降低术中低血压的发生率,减少麻黄素的使用,对新生儿无不良影响,且胶体液的这种效果优于晶体液。

Objective：To observe,under epidural anesthesia,the clinical effect of liquid volume expan-sion before the treatment of anaesthesia during cesarean section.Methods：60 pregnancies of the normal full-term birth from singleton caesarean section under epidural anesthesia were randomly divided into three groups,which were named A,B and C group respectively （n=30 cases/per group）.Group A were those for intravenous infusion of 6% hydroxyethyl starch and 130/0.4 sodium chloride injection before anesthesia,B were those for intravenous infusion of Sodium Lactate Ringer＆#39;s inj ection before anesthesia,and C were those for no pre-expansion before anesthesia,three groups were no preoperative medication.We provided a brief observation of changes of systolic blood pressure （SBP）,diastolic blood pressure （DBP）,heart rate （HR）, and neonatal Apgar score,the usage of nausea and vomiting and ephedrine among three groups of post-anes-thesia maternal.Results：Group A and B were lower than that of group C on the comparison in incidence of hypotension after anesthesia and the usage of ephedrine,which the difference was statistically significant （P＆lt;0.05）.Group A of hemodynamic,moreover,were more stable than group B.There was no statistically sig-nificant difference between the three groups of Neonatal Apgar score （P＆gt;0.05）.Conclusion：Using liquid ex-pansion before cesarean section under epidural anesthesia can not only reduce the incidence rate of intraopera-tive hypotension and the usage of ephedrine,but also have no adverse effect on the newborn.The effect of colloid was better than that of crystalloid solution.