目标导向液体治疗后子痫前期孕妇与健康孕妇脐带血血气异常的比较

A comparison of umbilical blood gas abnormalities between preeclampsia parturient and healthy parturient following goal directed fluid therapy

目的探讨目标导向液体治疗后子痫前期孕妇与健康孕妇脐带血血气异常的区别。方法行择期剖宫产术的健康孕妇26名（A组）、晚发型稳定期子痫前期孕妇26名（B组）。选用小剂量布比卡因（7．5mg）进行蛛网膜下腔硬膜外腔联合麻醉，在蛛网膜下腔麻醉给药同时采用LiDCOrapid系统提供的容量反应性参数[每搏量增加值（increment rate of stroke volume，ASV）]进行目标导向液体治疗使每搏量最优化，比较两组新生儿娩出后脐带血血气指标差异。结果B组需要第2次容量冲击的比例高于A组（54％比32％）。两组间低血压、血管活性药物用量等不良事件发生率差异无统计学意义（P〉0．05）。A组脐动脉血氧饱和度[（39±16）％比（30±12）％]、脐静脉血氧饱和度[（64±15）％比（52±19）％]显著高于B组（P〈0．05），脐动、静脉乳酸浓度[（1．54±0．18）mmol／L比（1．82±0．63）mmol／L；（1．49±0．26）mmol／L比（1．84±0．50）mmol／L]低于B组（P〈0．05）。结论目标导向液体治疗后，除脐动、静脉血氧饱和度及乳酸以外，晚发型稳定期子痫前期孕妇与健康孕妇间其余脐带血血气指标没有显著的区别。

Objective To investigate whether the incidences of umbilical blood gas abnormalities are different between preeclampsia parturient and healthy parturient following goal-directed fluid therapy. Methods Twenty six healthy parturient （group A） and twenty six stable preeclampsia parturient （group B） scheduled for elective cesarean section were recruited. Standard combined spinal epidural anesthesia was performed with low dose bupivacaine （7.5 mg）. At the time point of spinal injection, goaldirected fluid therapy was employed to optimize the stroke volume via the increment rate of stroke volume （ASV） provided by LiDCOrapid system. The umbilical blood gas abnormalities were recorded and analyzed. Results The ratio of parturient who needed second fluid challenge was higher in the preeclampsia group compared with the healthy control （54% vs32% ）. There were no significant differences in the maternal hypotension incidence and vasopressors used （P〉0.05）. In healthy parturient, the oxygen saturations in both umbilical artery [ （39±16）% vs （30±12）% ] and vein[ （64±15）% vs （52±19）% ] were significantly higher（P〈 0.05）, and level of lactic acid [ （1.54±0.18） mmol/L vs （ 1.82±0.63 ） mmol/L in umbilical artery, （1.49±0.26） mmol/L vs （ 1.84± 0.50） mmol/L in umbilical vein] were lower than that in the preeclampsia group （P〈0.05）. Conclusions Except for oxygen saturations and lactic acid, there were no significant differences in other umbilical blood gas parameters between stable preeclampsia parturient and healthy parturient following goal-directed fluid therapy in cesarean section.