单次腰麻剖宫产术中低血压原因分析及对策

Causes and Measures of Hypotension During Cesarean Section Under Spinal Anesthesia

目的:分析单次腰麻下剖宫产术中低血压的原因。方法:收集在2019年9月至2020年10月,赤几巴塔医院收治的219例麻醉前血压正常的剖宫产手术患者的临床资料进行回顾性分析,分析腰麻用药、麻醉平面、缩宫素用法及术中出血量差异对低血压发生率的影响。结果:与等比重布比卡因坐位腰麻比较,重比重布比卡因腰麻的麻醉平面更低[T(7.57±1.30)VS T(5.52±1.59),P<0.05]、低血压的发生率更低(12.14%VS 41.30%,P<0.05)、麻黄碱的用量均更小[(7.38±4.36)mg VS(17.37±7.88)mg,P<0.05],差异有统计学意义。静滴方式(VD)应用缩宫素的低血压的发生率(7.5%)显著低于静注方式(IV)的发生率(23.46%,P<0.05);术中出血量大于400mL的病例,将增加缩宫素的用量和手术中后期低血压的发生率。结论:采用麻醉同时快速补液、重比重坐位腰麻、使用血管收缩药物、静滴(VD)缩宫素和促进子宫收缩等措施,有利于维持剖宫产手术中循环稳定,降低低血压的发生率。

Objective:To study causes and measures of hypotension during cesarean section under spinal anesthesia.Methods:The clinical data of 219 parturients were retrospectively analyzed,who had normal blood pressure before anesthsia and had undergone cesaren section in hospital of Bata regional university,from SEP 2019 to OCT 2020.Investigating the correlation between hypotension and medicine of spinal anesthesia,anesthesia plane,the usage of oxytocin,and intraoperative blood loss.Result:As compared with parturients from isobaric bupivacaine under spinal anesthesia with sitting position,parturients from hyperbaric bupivacaine with sitting position had significantly lower anesthesia plane[T(7.57±1.30)VS T(5.52±1.59),P<0.05],hypotension incidence(12.14%VS 41.30%,P<0.05)and significantly smaller ephedrine dosage[(7.38±4.36)mg vs(17.37±7.88)mg,P<0.05].The incidence of hypotension of the parturients given oxytocin by interavenous drip(VD)(7.5%)was lower than that by intravenous injection(IV)(23.46%,P<0.05).Patients that blood losed above 400mL during operation,increased the dose of oxytocin and the incidence of hypotension.Conclusions:The measures of fluid infused rapidly as narcotizing,hyperbaric bupivacaine for spinal anesthesia with sitting position,the use of vasoconstroctor,oxytocin(VD),enhancing uterine contraction and so on can stabilize hemodynamics during cesarean scetion and reduse the incidence of hypotension.