孕期体质量增加对剖宫产手术中产妇心率变异性和低血压的影响

Effect of weight gain during pregnancy on heart rate variability and hypotension during caesarean section under spinal anaesthesia

目的探讨孕期体质量增加对剖宫产手术中产妇心率变异性（HRV）和低血压的影响。方法选择2011年1月至2013年12月132例产妇为研究对象,按照孕期增加体质量的不同分为3组。A组44例产妇孕期体质量增加小于11kg;B组44例产妇孕期体质量增加11~16kg;C组44例产妇孕期体质量增加大于16kg。统计3组术中麻醉、产妇血压、心率、术中低血压率、HRV及新生儿评分情况。结果 3组麻醉至分娩时间、术中收缩压、最低血压、心率、盐酸麻黄碱用量、阿托品术中用量,新生儿1min Apgar评分、新生儿5min Apgar评分比较,差异均无统计学意义（P〉0.05）。A组HRV各指标均大于B组和C组,差异有统计学意义（P〈0.01）;但B组和C组间比较,差异无统计学意义（P〉0.05）。A组低血压发生率明显高于B组、C组（χ2=10.579 7,P=0.005 0）,但B组、C组间比较,差异无统计学意义（P〉0.05）。结论孕期体质量增加较小的产妇行剖宫产麻醉时HRV增加,产妇低血压发生率增大,因此术中应密切监测相关指标。

Objective To study effect of weight gain during pregnancy on heart rate variability and hypotension during caesarean section under spinal anaesthesia.Methods A total of 132 pregnant women were selected as the object of study from January 2011 to December 2013.All the pregnant woman were divided into three groups according to the different increment of weight during pregnancy,with 44 cases in each group.Pregnancy women in the group A with pregnancy weight gain less than 11 kg.Pregnancy women in the group B with weight gain 11-16 kg.regnancy women in the group C with weight gain more than 16 kg.Statistics of intraoperative anesthesia,maternal blood pressure,heart rate and neonatal score,the rate of hypotension during operation,HRV and Apgar score were recorded.Results Time from anesthesia to delivery,the lowest blood pressure,heart rate,intraoperative systolic blood pressure,the dosage of ephedrine hydrochloride and atropine during operation,1 minutes and 5 minute Apgar score showed no statistical significant difference in the two groups（P〉0.05）.HRV parameters in the group A were higher than those of group B and group C,the difference was statistical significant（P〈0.01）,but there was no statistical significant difference between group B and group C（P〉0.05）.The incidence of hypotension in group A was higher than that in group B,group C（χ2=10.579 7,P=0.005 0）,but there was no significant difference between group B and group C（P〉0.05）.Conclusion HRV of women whose weight gain less than 11 kg during pregnancy increases during maternal cesarean section anesthesia,maternal hypotension risk increases,so indexes of them should be monitored closely during operation.