重度子痫前期孕妇与健康孕妇在腰硬联合麻醉下行剖宫产术发生低血压的风险比较

Combined spinal-epidural anesthesia-induced hypotension:a risk comparison between patients with severe preeclampsia and healthy women undergoing cesarean section

目的探讨腰硬联合麻醉（CSEA）用于重度子痫前期患者的安全性及有效性。方法选择重度子痫前期孕妇50例作为观察组,同期健康孕妇50例作为对照组,两组均在CSEA下行剖宫产术。比较两组孕妇术中血压及心率变化。结果重度子痫前期组低血压发生率明显高于健康孕妇组（P〈0.05）,观察组麻醉后平均动脉压（MAP）下降幅度明显大于对照组（P〈0.05）。重度子痫前期组麻黄碱使用剂量明显少于对照组（P〈0.05）,相对风险比（RR）1.940,95%可信区间为1.257-2.997。结论重度子痫前期孕妇低血压程度和发生率明显高于健康孕妇组,CSEA可用于重度子痫前期孕妇,但需注意防止低血压发生。

Objective To discuss the efficacy and safety of combined spinal-epidural anesthesia（CSEA） in patients with severe preeclampsia. Methods 50 severely preeclamptic patients were recruited as observe group and 50 healthy parturients as control group, who scheduled for elective cesarean section under CSEA.The hemodynamic effects of combined spinal-epidural anesthesia in patients with severe preeclampsia were compared with those of healthy parturients. Results The magnitude of the decrease in systolic blood pressure（SBP）,diastolic blood pressure（DBP） and mean blood pressure was significantly larger in patients with severe preeclampsia than those of healthy parturients （P〈0.05）. The incidence in hypotension was more in the severely preeclamptic group（P〈0.05 ）.Relative ratio calculation suggested that the risk of hypotension was almost four times more in patients with severe preeclampsia than that in healthy parturients （relative ratio, 1.940; 95% confidence interval：1.257-2.997）. The dosage of ephedrine given was lower in the severely preeclamptic group than that in healthy parturients（P〈0.05） Conclusion This prospective cohort study showed that the incidence and severity of hypotension were more in severely preeclamptic patients as compared with healthy parturients undergoing CSEA for cesarean delivery. Severe preeclampsia undergoing CSEA for cesarean delivery should note that adjusting the dose of anesthetic, strengthening intraoperative monitoring, and intraoperative fluid administration, were important measures to prevent and treat the severe complications on parturient and neonate.