剖宫产腰硬联合麻醉产妇在连续无创血压监测系统监测下不同液体预扩容的效果

Effect of Different Fluid Pre-expansion under Continuous Non-invasive Arterial Pressure in Cesarean Section Combined Spinal and Epidural Analgesia

目的:探讨分析剖宫产腰硬联合麻醉(CSEA)产妇在连续无创血压监测系统(CNAP)监测下不同液体预扩容的效果。方法:选取2019年9月-2020年9月在本院接受剖宫产的产妇180例,所有产妇均接受CNAP监测,进行CSEA,依据使用的不同预扩容液体种类来进行分组,羟乙基淀粉组60例,使用羟乙基淀粉(10 ml/kg);羟乙基淀粉+乳酸林格液组60例,使用羟乙基淀粉(5 ml/kg)+乳酸林格液(5 ml/kg);乳酸林格液组60例,使用乳酸林格液(10 ml/kg)。观察比较三组不同时间点(T0:进行预扩容之前的基础值,T1:麻醉后2 min,T2:麻醉后5 min,T3:麻醉后10 min,T4:麻醉后20 min,T5:术毕)CO、平均动脉压(MAP)及心率(HR)水平。比较三组低血压发生率、输液量、使用麻黄素量、出血量及尿量。比较三组新生儿Apgar评分。结果:与T0时相比,三组麻醉后各个时间点MAP水平均显著降低(P<0.05);与T0时相比,羟乙基淀粉组麻醉后各个时间点CO水平显著升高(P<0.05),乳酸林格液组麻醉后各个时间点CO水平显著降低(P<0.05);羟乙基淀粉+乳酸林格液组T0时与麻醉后各个时间点CO水平比较差异无统计学意义(P>0.05)。T0时,三组MAP、CO及HR水平差异均无统计学意义(P>0.05);麻醉后各个时间点,羟乙基淀粉组MAP与CO水平显著高于羟乙基淀粉+乳酸林格液组(P<0.05),羟乙基淀粉+乳酸林格液组的MAP与CO水平显著高于乳酸林格液组(P<0.05)。三组出血量及尿量差异均无统计学意义(P>0.05)。羟乙基淀粉组低血压发生率、输液量、使用麻黄素量均显著低于羟乙基淀粉+乳酸林格液组、乳酸林格液组(P<0.05);羟乙基淀粉+乳酸林格液组低血压发生率、输液量、使用麻黄素量均显著低于乳酸林格液组(P<0.05)。三组新生儿出生后1 min及出生后5 min的Apgar评分差异无统计学意义(P>0.05)。结论:剖宫产产妇CSEA术前在CNAP的监测下应用羟乙基淀粉(10 ml/kg)进行预扩容,可降低产妇在剖宫产术中发生低血压的风险,提高CO水平。

Objective:To investigate the effect of different fluid pre-expansion under continuous non-invasive arterial pressure(CNAP)in caesarean section combined spinal and epidural analgesia(CSEA).Method:A total of 180 parturients who received cesarean section in our hospital from September 2019 to September 2020 were selected.All parturients were monitored by CNAP,and received CSEA.According to the different types of pre-expansion liquids used,sixty patients in Hydroxyethyl Starch group were treated with Hydroxyethyl Starch(10 ml/kg);sixty cases in Hydroxyethyl Starch+Lactate Ringer’s Solution group were treated with hydroxyethyl starch(5 ml/kg)and Lactate Ringer’s Solution(5 ml/kg);sixty cases in Lactate Ringer’s Solution group were treated with Lactate Ringer’s Solution(10 ml/kg).The CO,mean arterial pressure(MAP)and heart rate(HR)levels were observed and compared between the three groups at different time points(T;:base value before pre-expansion,T;:2 min after anesthesia,T;:5 min after anesthesia,T;:10 min after anesthesia,T;:20 min after anesthesia,T;:at the end of operation).The incidence of hypotension,infusion volume,Ephedrine use,bleeding volume and urine volume in the three groups were compared.The Apgar score of newborns in three groups were compared.Result:Compared with T;,the MAP levels of the three groups decreased significantly at different time points after anesthesia(P<0.05);compared with T;,CO level in Hydroxyethyl Starch group increased significantly at each time points after anesthesia(P<0.05),the level of CO in Lactate Ringer’s Solution group decreased significantly at each time points after anesthesia(P<0.05);there were no significant differences in CO level between T;and each time points after anesthesia in Hydroxyethyl Starch+Lactate Ringer’s Solution group(P>0.05).At T;,there were no significant differences in MAP,CO and HR levels among the three groups(P>0.05);at each time point after anesthesia,MAP and CO levels in Hydroxyethyl Starch group were significantly higher than those in Hydroxyethyl Starch+Lactate Ringer’s Solution group(P<0.05),the MAP and CO levels in Hydroxyethyl Starch+Lactate Ringer’s Solution group were significantly higher than those in Lactate Ringer’s Solution group(P<0.05).There were no significant differences in blood loss and urine volume among the three groups(P>0.05).The incidence of hypotension,infusion volume,Ephedrine use in Hydroxyethyl Starch group were significantly lower than those in Hydroxyethyl Starch+Lactate Ringer’s Solution group and Lactate Ringer’s Solution group(P<0.05).The incidence of hypotension,infusion volume,Ephedrine use in the Hydroxyethyl Starch+Lactate Ringer’s Solution group were significantly lower than those in the Lactate Ringer’s Solution group(P<0.05).There were no significant differences in Apgar scores of newborns 1 min and 5 min postnatal between the three groups(P>0.05).Conclusion:Hydroxyethyl Starch(10 ml/kg)pre-expansion under CNAP monitoring before CSEA in cesarean section can reduce the risk of hypotension and improve the CO level.