应用LiDCOrapid监测缩宫素所致产妇血流动力学变化的临床观察

The application of LiDCOrapid system in observation of oxytocin induced-hemodynamic changes in obstetric patients undergoing caesarean section

目的 探讨LiDCOrapid提供的血流动力学指标能否在剖宫产手术患者中及时、有效地反映缩宫素引起的血流动力学改变.方法 选择美国麻醉医师协会（ASA）分级Ⅰ级,择期剖宫产手术20例,患者入室后应用LiDCOrapid指套、袖带建立无创血压监测（continuous noninvasive arterial blood pressure measurement,CNAP）.记录患者入室、胎儿娩出、给予缩宫素后即刻、给药后每间隔10s记录至给药后180 s时患者的血流动力学指标：收缩压（systolic blood pressure,SBP）、舒张压（diastolicblood pressure,DBP）、平均动脉压（mean arterial pressure,MAP）、心率（heart rate,HR）、心排血量（cardiac output,CO）、每搏量（stroke volume,SV）.记录患者缩宫素相关副作用.结果 给予缩宫素后,LiDCOrapid记录到患者HR、CO、SV增高,同时SBP、DBP、MAP下降,这与国外应用LiDCOplus建立有创动脉压监测所得血流动力学变化趋势一致.以胎儿娩出时血流动力学指标为基础值,SBP、DBP、MAP、HR、CO、SV均于给药后40 s～60 s达峰,达峰时相对基础值百分比分别为（89±12）％、（73±14）％、（81±12）％、（116±12）％、（174±35）％、（150±27）％,差异有统计学意义（P＜0.01）.结论 LiDCOrapid与LiDCOplus比较,二者具有一致性,均可及时、有效地反映剖宫产手术中缩宫素引起的快速血流动力学变化.健康产妇给予10单位负荷剂量缩宫素后,SBP、DBP、MAP下降,而HR、CO、SV升高.

Objective To validate whether the application of LiDCOrapid system could provide timely and effective monitoring in oxytocin-induced hemodynamic changes in obstetric patients undergoing caesarean section.Methods Twenty ASA Ⅰ obstetric patients undergoing elective caesarean section were set the continuous noninvasive arterial blood pressure measurement （CNAP） using the LiDCOrapid monitor in operating room.The real-time hemodynamic parameters,including systolic blood pressure （SBP）,diastolic blood pressure （DBP）,mean arterial pressure （MAP）,heart rate （HR）,cardiac output （CO） and stroke volume （SV） were recorded by LiDCOrapid-system at the time when parturient entering operating room,baby delivery and every 10 s after the oxytocin administration until 180 s.Oxytocin related side effects were also recorded.Results Following an intravenous bolus of 10 IU oxytocin,the increase of HR,SV,CO and the decrease of SBP,DBP,MAP were observed in all obstetric patients by LiDCOrapid system.These hemodynamic changes recorded by LiDCOrapid system were consistent with LiDCOplus system （an invasive arterial blood pressure measurement） recorded.We used the hemodynamic parameters when the baby delivery as the base value.The largest hemodynamic changes occurred at 40 s-60 s after oxytocin administration,SBP,DBP,MAP,HR,CO,SV changed to （89±12）%,（73±14）%,（81±12）%,（116±12）%,（174±35）%,（150±27）% of the base value respectively at that moment（P〈0.01）.Conclusions Compared to LiDCOplus,LiDCOrapid,a reliable non-invasive hemodynamic monitor is useful and sensitive in detecting oxytocin induced hemodynamic changes during caesarean section.Oxytocin induced hemodynamic changes included a rapid increase in HR,CO and SV,and meanwhile a quick decrease in blood pressure.