剖宫产椎管内麻醉产妇发生低血压的危险因素分析

Analysis of risk factors of hypotension in maternal after intrathecal anesthesia for caesarean section

目的探讨剖宫产椎管内麻醉产妇发生低血压的危险因素。方法选择我市三所医院产科2017年1月至2017年12月接受剖宫产椎管内麻醉的200例产妇为研究对象,将产妇按照血压不同分为低血压组(94例)和血压正常组(106例)。对产妇的临床资料进行单因素与Logistic多因素回归分析,构建低血压的预测模型。结果低血压组产妇基础心率、妊娠前基础体质指数高于血压正常组,孕期体重增长值低于血压正常组,差异具有统计学意义(P<0.05)。Logistic多因素回归分析显示,产妇基础心率及妊娠前基础体质指数是剖宫产椎管内麻醉产妇发生低血压的独立危险因素,孕期体重增长值是其独立保护因素(P<0.05)。产妇基础心率、妊娠前基础体质指数、孕期体重增长值的AUC分别为0.663、0.641、0.605。预测模型的AUC为0.708,95%CI为0.612～0.789,截断值、灵敏度及特异度分别为0.372、86.322%、49.356%。结论产妇基础心率、妊娠前基础体质指数及孕期体重增长值是剖宫产椎管内麻醉后低血压发生的影响因素。

Objective To explore the risk factors of hypotension in maternal after intrathecal anesthesia for caesarean section. Methods A total of 200 maternal undergoing intrathecal anesthesia for caesarean section from January 2017 to December 2017 in obstetrics department of three hospitals in our city were selected. The maternal were divided into hypotension group(94 cases) and normotensive group(106 cases) by different blood pressure. The clinical data of maternal were given univariate analysis and Logistic multivariate regression analysis, and the predictive model for hypotension was established. Results The basal heart rate and basal body mass index before pregnancy in the hypotension group were higher than those in the normotensive group, and the weight gain during pregnancy was lower than that in the normotensive group(P<0.05). Logistic multivariate regression analysis showed that the basal heart rate and the basal body mass index before pregnancy were independent risk factors of hypotension in maternal after intrathecal anesthesia for caesarean section, the weight gain during pregnancy was the independent protective factor(P<0.05). The AUC of basal heart rate, basal body mass index before pregnancy and weight gain during pregnancy were 0.663, 0.641 and 0.605 respectively. The AUC of prediction model was 0.708, 95% CI was 0.612-0.789, and truncation value, sensitivity and specificity were 0.372, 86.322% and49.356% respectively. Conclusion The basal heart rate, basal body mass index before pregnancy and weight gain during pregnancy are the influence factors of hypotension in maternal after intrathecal anesthesia for caesarean section.