不同补液方案对硬膜外麻醉下剖宫产产妇血压及新生儿Apgar评分的影响

Effects of different rehydration regimens on maternal blood pressure and neonatal Apgar scores in cesarean section under epidural anesthesia

目的探讨不同补液方案对硬膜外麻醉下剖宫产产妇血压及新生儿Apgar评分的影响。方法选取2017年1月至2018年1月于东阳市人民医院巍山分院进行硬膜外麻醉的剖宫产产妇100例为研究对象,采用随机数字表法将产妇分为观察组和对照组,每组50例。对照组采用开放性晶体补液,观察组采用限制性晶体补液。比较两组产妇血压变化、并发症发生率、术后恢复情况及新生儿Apgar评分。结果两组产妇术中各时刻的中心静脉压水平比较,差异均无统计学意义(均P>0.05)。经过不同方式的补液治疗,观察组产妇术后出血及低血压的发生率(8.00%、2.00%)均低于对照组(24.00%、14.00%),差异均有统计学意义(χ^2=4.762,P=0.029;χ^2=4.891,P=0.027)。补液后,观察组产妇剖宫产术后首次排气时间及术后24 h内出血量[(34.95±3.38)h、(271.36±27.18)mL]均少于对照组[(36.76±3.73)h、(298.56±30.21)mL],差异均有统计学意义(t=2.543,P=0.006;t=4.741,P=0.000)。经过不同方式的补液后,观察组1 min和5 min的新生儿Apgar评分[(8.95±1.31)分、(9.36±1.16)分]稍高于对照组[(8.76±1.23)分、(9.16±1.13)分],但是差异均无统计学意义(均P>0.05)。结论在调节血压方面,限制性晶体补液具有和开放性补液相似的作用,同时术后并发症发生概率更小,有助于产妇术后快速恢复,值得临床推广应用。

Objective To explore the effects of different rehydration regimens on maternal blood pressure and neonatal Apgar scores in cesarean section under epidural anesthesia. Methods From January 2017 to January 2018, 100 cesarean section women who underwent epidural anesthesia in Weishan Branch of Dongyang People's Hospital were enrolled. The women were randomly divided into observation group and control group according to the random number table method, with 50 cases in each group. The control group was treated with open crystal rehydration, and the observation group was treated with restrictive crystal rehydration. The blood pressure changes, complication rate, postoperative recovery and neonatal asphyxia scores of the two groups were compared. Results There was no statistically significant difference in the central venous pressure at all time between the two groups (all P>0.05). After different methods of fluid replacement, the incidence rates of postoperative bleeding and hypotension in the observation group(8.00%, 2.00%) were lower than those in the control group(24.00%, 14.00%), and the differences were statistically significant (χ^2=4.762, P=0.029;χ^2=4.891, P=0.027). After rehydration, the first exhaust time after cesarean section and the amount of bleeding within 24 h after operation in the observation group[(34.95±3.38)h,(271.36±27.18)mL] were lower than those in the control group[(36.76±3.73)h,(298.56±30.21) mL], the differences were statistically significant (t=2.543, P=0.006;t=4.741, P=0.000). After different methods of rehydration, the Apgar scores of the newborns at 1 min and 5 min after cesarean section in the observation group[(8.95±1.31)points,(9.36±1.16)points] were slightly higher than those of the control group[(8.76±1.23)points,(9.16±1.13)points], but there were no statistically significant differences between the two groups (all P>0.05). Conclusion In regulating blood pressure, restrictive crystal rehydration has similar effects as open rehydration, and the incidence rate of postoperative complications is lower, which is helpful for rapid recovery after maternal surgery, and is worthy of clinical application.