剖宫产腰麻后低血压发生的危险因素初步分析

Risk factors for spinal anesthesia-induced hypotension during cesarean delivery:a pilot study

目的初步筛选剖宫产腰麻后患者发生低血压的危险因素。方法选择2018-11/2020-01期间在我院行择期剖宫产的产妇76名,年龄24~42岁,平均年龄为32岁,经筛选最终纳入70例患者作为研究对象。患者于腰硬联合麻醉下行剖宫产手术,以收缩压(SBP)低于90 mmHg定义低血压,统计腰麻后低血压(SAIH)的发生。用χ^2检验分别评估:(1)自身危险因素:年龄、身高、体质量、BMI、术前血红蛋白水平、术前基础收缩压力;(2)胎儿危险因素:胎儿体质量、羊水量、胎盘重量及三者总重量;(3)患者合并症及麻醉危险因素:妊娠期糖尿病、术前贫血、ASA分级、不需要追加硬膜外药物。进一步采用多因素分析(Logistic回归)研究各危险因素与SAIH发生的相关性。结果产科SAIH的发生率为52.9%;单因素分析显示年龄≥32岁、硬膜外不需要追加药物对SAIH发生的影响差异具有统计学意义。多因素分析显示年龄≥32岁、硬膜外不需要追加药物与SAIH的发生相关性较高(OR值>1,P<0.05),是SAIH发生的独立危险因素。结论产科SAIH的发生率为52.9%。年龄≥32岁、硬膜外不需要追加药物是SAIH发生的独立危险因素。通过早期识别SAIH发生的危险因素,及时预防和应对低血压发生,更好的保障母婴安全。

Objective To investigate risk factors for spinal anesthesia-induced hypotension(SAIH)in parturients during cesarean delivery.Methods A total of 76 parturients aged 24-42 years,undergoing elective cesarean delivery in Qilu hospital of Shandong university(Qingdao)from November 2018 to January 2020 were selected.The average age is 32 years old.Altogether 70 patients were selected and included in the study.SAIH was defined as systolic pressure lower than 90 mmHg.Chi-square test was performed to evaluate:(1)self-risk factors:age,height,body mass,BMI,preoperative hemoglobin level,preoperative basal systolic pressure;(2)fetal risk factors:fetal weight,amniotic fluid volume,placental weight and the total weight of them;(3)maternal complications and risk factors of anesthesia:gestational diabetes mellitus,preoperative anemia,American Society of Anesthesiologists classification,the absence of epidural drugs.Multivariate analysis(Logistic regression)was further used to investigate the correlation between risk factors and the occurrence of SAIH.Results The incidence of SAIH in obstetrics was 52.9%.The univariate analysis showed that there were statistically significant differences in parturients≥32 years and being absent of epidural drugs on the occurrence of SAIH.Multivariate analysis showed that the age≥32 years and the absence of epidural drugs had a higher correlation with the occurrence of SAIH(OR value>1,P<0.05),which was the independent risk factor for the occurrence of SAIH.Conclusion The incidence of SAIH in obstetrics is 52.9%.The independent risk factors of SAIH were the age≥32 years old and the absence of epidural drugs.Through early identification of risk factors for SAIH,timely prevention and response to the occurrence of hypotension,the maternal and child safety can be better guaranteed.