腰麻后左侧倾斜体位对产妇以及新生儿的心肌酶和肌钙蛋白的影响

Effects of left oblique position on the myocardial enzymes and troponin in maternal and neonates after spinal anesthesia

目的探讨对剖宫产产妇采用腰麻后左侧倾斜体位后对产妇以及新生儿的心肌酶和肌钙蛋白的影响。方法选取我院2017年5月～2018年4月的120例选择剖宫产的产妇,将此120例产妇随机分为对照组和观察组,每组各60例,观察组在腰麻后将产妇平卧,而后将手术床向产妇左侧倾斜30°;对照组在腰麻后予以常规平卧位。记录两组的产妇在麻醉前、麻醉后即刻、手术开始以及胎儿娩出后的血压。记录两组胎儿娩出后的新生儿脐动脉血气分析、心肌酶以及肌钙蛋白的水平。结果两组产妇中发生低血压的产妇有50例,其中对照组有39例,观察组有11例,两组差异具有统计学意义(P<0.05);观察组的产妇在手术开始时以及胎儿娩出时的收缩压较对照组高,差异有统计学意义(P<0.05);观察组的LDH和CK-MB低于对照组,差异有统计学意义(P<0.05);观察组的新生儿脐动脉血气分析pH值和PaO2高于对照组,差异有统计学意义(P<0.05)。结论腰麻后左侧倾斜体位能够明显减少腰麻后剖宫产产妇的低血压的发生率以及低血压发生程度,从而减少因麻醉而产生的一系列并发症,改善新生儿的缺氧缺血的情况。

Objective To investigate the effects of left oblique position after spinal anesthesia on the myocardial enzymes and troponin of maternal and neonatal infants after cesarean section.Methods 120 women who underwent cesarean section from May 2017 to April 2018 in our hospital were selected and randomly divided into two groups,the control group and the observation group,each with 60 cases.The patients in the observation group were placed supine after the spinal anesthesia,and then the operating bed was tilted 30°to the left side;the patients in the control group were placed in the usual supine position after spinal anesthesia.The blood pressures of patients in the two groups were recorded before the anesthesia,immediately after the anesthesia,at the start of the operation,and at the delivery of the fetus.The umbilical arterial blood gas analysis,myocardial enzymes and troponin levels of the newborns in both groups after delivery were recorded.Results Between the two groups,50 patients had hypotension,including 39 in the control group and 11 in the observation group,and the difference between the two groups was statistically significant(P<0.05).The systolic blood pressure of patients in the observation group at the beginning of the operation and at the time of delivery was higher than that of the control group,and the difference was statistically significant(P<0.05).The LDH and CK-MB in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).The pH value and PaO2 of umbilical arterial blood gas analysis in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The left oblique position after spinal anesthesia can significantly reduce the incidence of hypotension and the degree of hypotension in patients after cesarean section,thereby reducing a series of complications caused by anesthesia and improving hypoxia and ischemia in newborns.