剖宫产蛛网膜下腔阻滞产妇发生低血压的相关因素

Related factors of hypotension in parturients with subarachnoid block after cesarean section

目的分析剖宫产蛛网膜下腔阻滞产妇发生低血压的相关因素,为防治低血压提供参考。方法回顾性分析2018年1—12月杭州市妇产科医院320例在蛛网膜下腔阻滞下行子宫下段横切口剖宫产产妇的临床资料,分析阻滞后发生低血压的相关因素以及处理情况,并采用Logistic回归分析筛选发生低血压的危险因素(产妇因素、胎儿因素、麻醉因素、体位因素和Bezold-Jarisch反射)。结果320例产妇发生低血压143例(44.69%),其中95例(66.43%)单次静脉注射麻黄碱10 mg纠正低血压,48例(33.57%)多次静脉注射麻黄碱10 mg纠正低血压。Logistic回归分析结果表明,宫高>36 cm、巨大儿、多胎妊娠、体质量指数(BMI)≥28 kg/m2、阻滞平面≥T6、注药速度≤10 s、仰卧位、Bezold-Jarisch反射是蛛网膜下腔阻滞后发生低血压的危险因素(P<0.05),其中巨大儿、多胎妊娠、BMI≥28 kg/m2、阻滞平面≥T6、注药速度≤10 s、仰卧位、Bezold-Jarisch反射是需多次注射麻黄碱才能纠正低血压的危险因素(P<0.05)。结论宫高、巨大儿、多胎妊娠、肥胖、阻滞平面、注药速度、体位、Bezold-Jarisch反射是产妇蛛网膜下腔阻滞后发生低血压的危险因素,剖宫产手术时应充分考虑,确保产妇和胎儿安全。

Objective To analyze the related factors of hypotension in lying-in women with subarachnoid block during cesarean section and provide reference for the prevention and treatment of hypotension.Methods The clinical data of 320 women with subarachnoid block who underwent cesarean section at the lower segment of the uterus from January to December 2018 in Hangzhou Women′s Hospital were analyzed retrospectively.The related factors of hypotension and treatment status after subarachnoid block were analyzed.Logistic regression analysis was used to screen the risk factors for hypotension(maternal factors,fetal factors,anesthetic factors,body position factors and Bezold-Jarisch reflex).Results Among the 320 subjects,143(44.69%)had hypotension.Among the patients with hypotension,95(66.43%)patients were given single intravenous injection of 10 mg of ephedrine to treat hypotension and 48(33.57%)patients were given multiple intravenous injection of 10 mg of ephedrine to treat hypotension.It was showed by Logistic regression analysis that uterine height>36 cm,macrosomia,multiple pregnancies,body mass index(BMI)≥28 kg/m2,block plane≥T6,injection speed≤10 s,supine position,Bezold-Jarisch reflex were the risk factors for hypotension after subarachnoid block(P<0.05).Among them,hypotension related to macrosomia,multiple pregnancies,BMI≥28 kg/m2,block plane≥T6,injection speed≤10 s,supine position,Bezol-Jarisch reflex required multiple injections of ephedrine to be treated(P<0.05).Conclusion Uterine height,macrosomia,multiple pregnancies,obesity,block plane,injection speed,body position,Bezol-Jarisch reflex are risk factors for hypotension after subarachnoid block in puerpera,which should be fully considered during cesarean section to ensure the safety of puerpera and fetus.