剖宫产术中产妇寒战与羊水入血关系的探索

Exploration of the relationship between puerperal shivering and amniotic fluid entering into the blood during cesarean section

目的探讨剖宫产术中寒战与羊水入血的关系,为预防和治疗剖宫产术中寒战提供新的思路。方法采用前瞻性双盲病例对照研究。ASA分级Ⅰ、Ⅱ级产妇57例,全部采用蛛网膜下腔阻滞麻醉,麻醉医师观察产妇术中寒战程度并分级。记录产妇的一般情况(姓名、年龄、身高、体重)、出血量、液体入量、孕龄、新生儿体重、手术时长、新生儿1 min Apgar评分和寒战分级等,测量并记录产妇麻醉前、麻醉后30 min、术终3个时点的肛温。按照Dewitte寒战分级法将产妇分为4组:0级为非寒战组(0组),寒战1~3级分别为1组、2组、3组,其中1、2、3组合称寒战组。所有产妇均于手术结束前抽取静脉血2 ml检测唾液酸Tn(sialyl Tn,sTn)抗原浓度。分别对寒战程度与sTn抗原浓度、孕龄、出血量、液体入量、手术时长、新生儿体重、3个时间点肛温关系进行相关性分析。结果各组产妇年龄、身高、体重、出血量、液体入量、孕龄、新生儿体重、手术时长、3个时间点肛温比较,差异无统计学意义(P>0.05)。2组和3组sTn抗原浓度明显高于0组和1组(P<0.05),1组sTn抗原浓度明显高于0组(P<0.05)。寒战组sTn抗原浓度明显高于非寒战组(P<0.05)。寒战程度和sTn抗原浓度的相关系数为0.895(P<0.01),而孕龄、出血量、液体入量、手术时长、新生儿体重、3个时点肛温与寒战程度并无相关性。结论剖宫产术中产妇寒战与羊水入血相关。

Objective To investigate the relationship between shivering and amniotic fluid entering into the blood during ce sarean section,and provide new thoughts for prevention and treatment of shivering during cesarean section.Methods This was a prospective,double blinded,and controlled study.A total of 57 puerperants[American Society of Anesthesiologists(ASA)ⅠorⅡ]re ceived subarachnoid block,whose shivering were observed and classified by chief anesthesiologists.Their general information(name,age,height and weight),blood loss,fluid intake,gestational age,neonatal weight,the length of operation,neonatal 1 minute Apgar score and shivering grade were recorded.Their anal temperatures before anesthesia,30 min after anesthesia and at the end of the operation were measured and recorded.The puerperants were divided into four groups according to Dewitte shivering classification:grade 0 is a non shivering group(group 0);shivering grades 1 to 3 were divided into groups 1,2 and 3,respectively,where groups 1 to 3 were de fined as shivering groups.Then,2 ml of venous blood were taken from all the puerperants before the end of the operation to detect the concentration of sialyl Tn(sTn)antigen.The correlations between shivering degree and sTn antigen concentrations,gestational age,blood loss,fluid intake,the length of operation,neonatal weight and anal temperature at three time points were analyzed.Results There was no significant difference in age,height,weight,blood loss,fluid intake,gestational age,neonatal weight,the length of opera tion,and anal temperature at three time points among these groups(P>0.05).Compared to groups 0 and 1,groups 2 and 3 produced higher concentrations of sTn antigen(P<0.05),while the concentration of sTn antigen in group 1 was higher than that in group 0(P<0.05).The concentrations of sTn antigen in the shivering groups were significantly higher than that in the non shivering group(P<0.05).The correlation coefficient between shivering degree and sTn antigen concentration was 0.895(P<0.01).There was no correlation be tween shivering degree and gestational age,blood loss,fluid intake,the length of operation,neonatal weight and anal temperature at three time points.Conclusions Puerperant shivering is related with amniotic fluid entering into the blood during cesarean section.