腰硬联合麻醉下剖宫产术中去氧肾上腺素与羟乙基淀粉即时扩容对产妇血流动力学及胎儿酸碱值的影响

Effect of Immediate Dilation of Phenylephrine and Hydroxyethyl Starch on Maternal Hemodynamics and Fetal pH Value During Cesarean Section Under Combined Spinal Epidural Anesthesia

目的:探讨腰硬联合麻醉下剖宫产术中去氧肾上腺素与羟乙基淀粉即时扩容对产妇血流动力学及胎儿酸碱值的影响。方法:选择2015年3月至2016年2月我院符合入选标准的行腰硬联合麻醉下择期剖宫产产妇51例,按照术中处理低血压方式的不同,分为去氧甲状腺素组(P组)及羟乙基淀粉即时扩容组(C组)。比较产妇麻醉前以及麻醉后不同时间点平均动脉压(MAP),心率(HR),标每博输出量(SV)以及心输出量(CO),比较两组产妇脐静脉血液血气分析结果;新生儿娩出后1min和5min时Apgar评分情况以及麻醉开始至新生儿娩出时间(IDI)。结果:两组产妇平均动脉压,每博心输出量以及心输出量在各时间点均无显著性差异(P>0.05)。两组产妇的心率均先升高再降低然后在升高,C组的心率在T2、T3、T4、T5、T6、T7以及T8等不同时间点均比同一时间P组显著降低,差异具有统计学意义(P<0.05)。两组产妇的脐静脉血中的PH、PO_2、PCO_2以及HCO_3均趋于正常范围,两组间无统计学差异(P>0.05),两组产妇剖宫产时间,新生儿断脐带后1min以及5min AParg评分无显著性差异(P>0.05)。结论:择期剖宫产术中腰硬联合麻醉并羟乙基淀粉即时扩容能明显降低低血压发生,去氧肾上腺素能维持产妇的体循环稳定,且不增加心脏做功,对新生儿血气影响小。

Objective：To explore the effect of maternal hemodynamics and fetal acid-base values of immediate expansion of hydroxyethyl starch and phenylephrine hydrochloride on combined spinal-epidural analgesia.Methods： According to the different ways of dealing with hypotension,51 cases of elective cesarean section under combined spinal-epidural analgesia were divided into two groups： Phenylephrine hydrochloride group （group P） and Hydroxyethyl starch immediate expansion group （group C）.Mean arterial pressure, heart rate, standard volume of output and cardiac output （CO） at the time of anesthesia and post anesthesia between the two groups were compared.The blood gas results of umbilical vein blood of the two groups were compared.Apgar scores at 1 min and 5 min after delivery, and the time from anesthesia to neonatal delivery （IDI） of the two groups were compared.Results： There was no significantly difference of mean arterial pressure, cardiac output and cardiac output between the two groups （P〉 0.05）.The heart rate of the two groups were increased and then decreased, then increased.The heart rate of group C was significantly lower than that of group P at T2, T3, T4, T5, T6, T7 and T8 （P 〈0.05）.The levels of pH, PO2, PCO2 and HCO3 in the umbilical vein blood of the two groups were all within the normal range, there was no significantly difference between the two groups （P〉0.05）.The duration of cesarean section, and Aparg score at 1 minute and 5 minutes after umbilical cord cut short were no significantly difference （P〉 0.05）.Conclusion： Combined spinal-epidural analgesia with hydroxyethyl starch immediate expansion can obviously reduce the hypotension at elective cesarean section;deoxidation adrenaline can maintain the maternal systemic stability, and does not increase heart work, little influence on newborn blood gas analysis.