双胎与单胎产妇蛛网膜下腔阻滞后血流动力学变化特点比较

Comparison of maternal hemodynamic changes during spinal anesthesia for cesarean section between twin and singleton parturients

目的比较双胎与单胎产妇在接受蛛网膜下腔阻滞(spinal anesthesia,SA)后剖宫产术中的血流动力学变化特点。方法纳入同期行择期剖宫产手术的双胎与单胎产妇各40例,通过无创心输出量监测仪(NICOM)测定SA前后以及剖宫产术中不同时间点的心输出量(cardiac output,CO)、每搏量(stroke volume,SV)、心率(heart rate,HR)、总外周血管阻力(total peripheral vascular resistance,TPR)和平均动脉压(mean arterial pressure,MAP),同时比较2组低血压发生率、平均血管活性药物的用量及最高阻滞平面等。结果双胎组产妇的CO和SV在SA后持续下降,不同时间点均低于单胎组(P<0.05),而2组的HR在SA后均上升,但组间差异无统计学意义(P>0.05)。SA后2组的TPR均开始下降,但与基础值差异无统计学意义(P>0.05),单胎组的TPR在SA后的几个时点显著低于双胎组(P<0.05)。2组MAP在SA后均下降,在第10分钟时双胎组显著低于单胎组(P<0.05)。双胎组SA后的低血压发生率、血管活性药用量和最高阻滞平面均显著高于单胎组(P<0.05)。结论SA对双胎产妇的血流动力学有显著的影响,尤其心输出量和血压降低均较单胎产妇明显。

Objective To compare maternal hemodynamic parameters during spinal anesthesia(SA)in twin and singleton parturients undergoing elective cesarean section(CS). Methods Forty parturients with twin gestation(twin group)and 40 singleton controls(singleton group)under SA for elective CS were enrolled. Cardiac output(CO), stroke volume(SV), heart rate(HR), mean arterial pressure(MAP), and total peripheral vascular resistance(TPR)were continuously measured by NICOM monitor. The incidence of hypotension, vasopressor dose, and the highest cephalad level of spinal block were compared between two groups. Results CO and SV in twin group continuously decreased and were significantly lower than those in singleton group at different time point after SA(P<0.05). There was no difference of HR between two groups(P>0.05). TPR in two groups also fell after SA, but the decrease had no significant difference compared to the baseline value(P>0.05). While the TPR in singleton group was lower than that in twin group at predefined time points after SA(P<0.05). There was a prominent decrease in MAP of two groups after SA compared with baseline, and MAP in twin group was lower than that in singleton group at 10 min after SA(P<0.05). The incidence of hypotension, doses of phenylephrine and level of spinal block were higher in twin group than those in singleton group(P<0.05). Conclusion Parturients with twin pregnancy exhibit greater hemodynamic instability with significant decrease in CO and MAP after SA compared to those with singleton pregnancy.