无创瞬时血压监护下缩宫素不同用法对产妇血流动力学的影响

Effects of different uses of oxytocin on hemodynamics of parturient women under non-invasive transient blood pressure monitoring

目的探讨缩宫素不同静脉给药方式对产妇血流动力学及相关不良反应的影响。方法随机选取2017年6月至2018年1月术前不合并有产后出血高风险因素的足月妊娠行剖宫产产妇38例,分为两组(HO组和LO组),每组19例,术中以无创瞬时血压监护仪监测即时血压,两组产妇在胎儿娩出后给于缩宫素10 U子宫体肌注,HO组在LO组的基础上经静脉缓慢推注缩宫素5 U(10 ml,1 min注射完毕),继之两组均以10 U缩宫素加入500 ml林格氏液中持续滴注(250 ml/h),观察两组产妇的血流动力学变化及不良反应。结果两组产妇在术中和术后24 h失血量、胎盘自然剥离时间上比较差异无统计学意义;两组产妇在给于缩宫素30 s后收缩压、舒张压开始下降,心率逐渐增快,与HO组比较,LO组血流动力学变化较小,差异有统计学意义(P<0.05);在不良反应方面,LO组恶心呕吐、呼吸困难、心肌缺血的发生率明显低于HO组,差异有统计学意义(P<0.05)。结论剖宫产术中使用10 U缩宫素子宫体肌注和缓慢静脉持续滴注,能保持术中产妇的血流动力学稳定,且不良反应小,安全性高。

Objective To explore the different intravenous oxytocin administration way affect maternal hemodynamics and the related side effects.Methods Randomly selected in June 2017 to January 2018 preoperative full-term pregnancy cesarean section maternal 38 cases of no postpartum hemorrhage high-risk factors,divided into 2 groups (HO and LO group),19 cases in each group,instantaneous blood pressure was monitored with non-invasive instantaneous blood pressure monitor during surgery.The two groups of mothers give oxytocin 10 U intrauterine injection after delivery of the fetus,In the HO group,the oxytocin 5 U (10 ml,1 minute injection) was slowly intravenously injected on the basis of the LO group,followed by continuous instillation of 10 U oxytocin in 500 ml of Ringer's solution (250 ml/h).Observe the hemodynamic changes and side effects of maternal women in both groups.Results There was no statistically significant difference in blood loss and placental natural peeling time between the two groups of women during and after surgery.The systolic blood pressure and diastolic blood pressure of the two groups of maternal women began to decline after 30 s of oxytocin,and the heart rate gradually increased.Compared with the HO group,the hemodynamic changes in the LO group had a small difference (P<0.05).In terms of side effects,LO group nausea and vomiting,dyspnea,myocardial deficiency HO was significantly lower than the group,the difference was statistically significant (P<0.05).Conclusion The use of intramuscular injection of 10 U oxytocin in the cesarean section and continuous infusion of slow intravenous infusion can maintain the hemodynamic stability,low adverse reactions,and high safety of the intraoperative maternal hemodynamics.