不同液体预扩容对腰硬联合麻醉剖宫产术产妇血流动力学的影响

Effect of different fluids pre-expansion on hemodynamics to parturient for combined spinal epidural anesthesia for cesarean section

目的:观察连续无创血压监测系统(CNAP monitor 500)监测下使用不同液体预扩容对腰硬联合麻醉行剖宫产的产妇血流动力学的影响。方法:选取90名产妇,使用CNAP监测连续无创血压及心输出量,按不同预扩容液体随机平均分成3组,A组羟乙基淀粉10 ml·kg^(-1),B组羟乙基淀粉5 ml·kg^(-1)加乳酸林格液5 ml·kg^(-1),C组乳酸林格液10 ml·kg^(-1),在腰硬联合麻醉之前进行预扩容,观察3组产妇设定时间点心率、平均动脉压(MAP)、心输出量(CO),观察3组产妇手术时间、术中低血压情况、输液量、麻黄素使用量、出血量、尿量、肺水肿、异常产后出血情况、新生儿1 min和5 min Apgar评分。结果:3组产妇麻醉后各时间点MAP与基础值比较均明显下降(P<0.05),A组各时间点CO较基础值显著升高(P<0.05),C组各时间点CO较基础值显著下降(P<0.05)。不同组别各时间点的MAP、CO比较,A组显著高于B组,B组显著高于C组(P<0.05)。3组产妇术中发生低血压例数、输液量、追加麻黄素总量比较,A组显著少于B组,B组显著少于C组(P<0.05)。结论:CNAP监测下使用羟乙基淀粉10 ml·kg^(-1)对腰硬联合麻醉行剖宫产术前的产妇进行预扩容,能提高产妇CO,减少低血压的发生。

Objective： To investigate the effects of different fluids pre-expansion on hemodynamies to parturient for combined spinal epidural anesthesia for cesarean section supervised by continuous non-invasive arterial pressure monitoring system（ CNAP monitor 500）. Methods： 90 maternal women were included in this study with continuous non-invasive arterial pressure and cardiac output monitored by CNAP. They were randomly divided into 3 groups according to different pre-expansion fluids, in group A the fluid was hydroxyethyl starch 10 ml · kg-1; in group B the fluid was hydroxyethyl starch 5 ml · kg-1 lactated Ringer solution 5 ml· kg-1; in group C the fluid was lactated Ringer solution 10 ml · kg-1 The three fluids were used for pre-expansion before spinal epidural anesthesia. The heart rate, mean arterial pressure （MAP） , cardiac output （CO） of the women in the three groups at specific time points were recorded respectively. The surgery time, incidence of intraoperative hypotension, transfusion volume, additional ephedrine volume, bleeding volume, urine volume, incidence of pulmonary edema, abnormal postpartum hemorrhage, neonates Apgar score of 1 min and 5 min were evaluated. Results： In all the 3 groups, MAP value at each time point after anesthesia was significantly lower than that of baseline （P 〈 0.05 ）. In group A at all time points, CO was significantly higher compared to baseline （P 〈 0.05 ） ; yet in group C, CO was significantly lower compared to baseline （P 〈 0.05 ）. In the comparison of MAP and CO level of each time point, group A was significantly higher than group B, group B was significantly higher than group C （P 〈 0.05 ）. Regarding the incidence of intraoperative hypotension, transfusion volume, additional ephedrine volume in the 3 groups, group A was significantly lower than group B, group B was significantly lower than group C （P 〈 0.05 ）. Conclusion： Pre-expansion with hydroxyethyl starch 10 ml · kg-1supervised by CNAP for combined spinal epidural anesthesia for cesarean section can improve maternal cardiac output, reduce the incidence of hypotension.