蛛网膜下腔阻滞剖宫产手术期间的血流动力学观察

Hemodynamic Observation of Subarachnoid Block Anesthesia During Cesarean Section

目的探讨蛛网膜下腔阻滞剖宫产手术期间的血流动力学变化特点。方法 60例ASA I～II级的择期行剖宫产术的单胎足月产妇,于L3-4间隙行腰-硬联合穿刺,蛛网膜下腔注入等比重的布比卡因(0.5%,10 mg),观察记录四个时间期的最低SBP:T0,入室后麻醉开始前;T1,蛛网膜下腔注射药物完毕后5 min内;T2,左倾体位回正后5 min内;T3,胎儿取出后5 min内;术中维持血压和心率的稳定,新生儿出生后行脐动脉血气分析,记录新生儿Apgar评分;并记录产妇麻醉术中麻黄碱及阿托品用量、出血量、尿量、低血压及恶心、呕吐等不良反应发生情况。结果 T1、T2、T3三个时间期与T0收缩压降低均值(△SBP)分别为(29.08±7.21),(24.58±8.62),(21.35±8.36)mm Hg,T1、T2、T3各时间期与T0收缩压下降值差异有统计学意义(P <0.001);T1、T2、T3三个时间期恶心呕吐发生率分别为38例(63%)、26例(43%)、23例(38%);T1、T2、T3三个时间期的收缩压变化(△SBP)与恶心呕吐不良反应成呈正相关(P <0.05)。结论 T1、T2、T3是剖宫产期间三个容易出现低血压的时间,恶心、呕吐等不适也容易发生。产妇对血压的波动较敏感,理想的△SBP波动幅度应该控制在更小的范围,推荐△SBP <15%,甚至<10%。

Objective To analyze the hemodynamic variation characteristics during subarachnoid block anesthesia for cesarean section.Methods Sixty women with singleton pregnancies at term,who were graded American Society of Anesthesiologists statuses I or II and who were undergoing elective Cesarean section,were included in this study.All women underwent puncture at the L3-4 interspace using the combined spinal– epidural technique;isobaric bupivacaine(0.5%,10 mg)was injected into the subarachnoid space.The lowest systolic blood pressure values(SBP)during four time periods were observed and recorded:T0,entry into the operating room and before anesthesia;T1,within 5 minutes after subarachnoid drug injection;T2,within 5 min after recovery from left lateral tilt position;T3,within 5 minutes after delivery;umbilical artery blood gases analysis was performed after birth,Apgar scores was recorded;dosage of ephedrine and atropine,intraoperative blood loss,urine volume,hypotension,nausea,vomiting,and incidences of other adverse events were recorded.Results The mean differences in systolic pressure between T0 and T1,T2,and T3(△SBP)were(29.08±7.21)mmHg,(24.58±8.62)mmHg,and(21.35±8.36)mmHg,respectively.Results showed statistically significant differences in the reduction of systolic pressure between T0 and each of the subsequent time periods(P<0.001).The incidence of nausea and vomiting in T1,T2 and T3 were 38 cases(63%),26 cases(43%)and 23 cases(38%),respectively.The changes of SBP(△SBP)in T1,T2 and T3 were positively correlated with nausea and vomiting(P<0.05).Conclusion T1,T2,T3 are represent time periods during Cesarean section in which there is a tendency for hypotension,nausea,vomiting,and other discomfort to occur.Parturients are sensitive to blood pressure fluctuations,ideally,△SBP should be kept within a smaller range,and it is recommended that△SBP<15%or even<10%.