利用LiDCO-rapid行目标导向液体治疗对剖宫产术中血流动力学的影响

Effect of Goal-directed Fluid Therapy with LiDCO-rapid on Hemodynamics in Cesarean Section

目的探讨LiDCO-rapid行目标导向液体治疗对剖宫产术中血流动力学的影响。方法选择2020年1月至2021年1月在安徽医科大学附属巢湖医院行剖宫产的60例产妇作为研究对象,根据胶体液输注方式不同分为观察组和对照组,每组30例。除常规的血压、心电图、血氧饱和度监测外,两组均通过LiDCO-rapid监测心率、平均动脉压、心排血量、左心室搏出量、每搏量变异,建立静脉通路后,观察组和对照组分别于脊髓麻醉前和麻醉后静脉快速输注6%羟乙基淀粉溶液130/0.4250 ml,10 min内输注完毕。比较两组左仰卧位基础值(T_(0))、脊髓麻醉后即刻(T_(1))、切皮时(T_(2))、胎儿娩出时(T_(3))、手术结束时(T_(4))的血流动力学参数(心率、平均动脉压、心排血量、左心室搏出量和每搏量变异),以及并发症发生情况和去氧肾上腺素用量。结果两组产妇麻醉平面、失血量、手术时间比较差异无统计学意义(P>0.05)。心率组间和时点间的主效应差异无统计学意义(P>0.05),组间和时点间无交互作用(P>0.05)。平均动脉压、心排血量、左心室搏出量、每搏量变异组间和时点间的主效应差异有统计学意义(P<0.01),且组间和时点间均存在交互作用(P<0.01),两组麻醉后平均动脉压有不同程度的下降,但观察组高于对照组(P<0.05)。观察组脊髓麻醉后T_(1)、T_(2)和T_(3)时的平均动脉压、心排血量、左心室搏出量明显高于对照组,但每搏量变异明显低于对照组(P<0.05)。观察组恶心呕吐、低血压的发生率低于对照组[36.7%(11/30)比66.7%(20/30),30.0%(9/30)比63.3%(19/30)](P<0.05),去氧肾上腺素用量少于对照组[(40.6±9.1)μg比(96.9±19.2)μg](P<0.01)。结论脊髓麻醉前输注胶体液可提高平均动脉压、心排血量、左心室搏出量并有效预防低血压,且脊髓麻醉下剖宫产术中血流动力学更稳定。

Objective To investigate the effect of goal-directed fluid therapy with LiDCO-rapid on hemodynamics during cesarean section.Methods Sixty pregnant women undergoing elective cesarean section admitted to Chaohu Hospital,Anhui Medical University from Jan.2020 to Jan.2021 were included and divided into an observation group and a control group according to the way of colloid infusion,30 cases each.In addition to routine monitoring of blood pressure,electrocardiogram and blood oxygen saturation,LiDCO-Rapid was used to monitor heart rate,mean arterial pressure,cardiac output,left ventricular stroke volume and stroke volume variation in both groups.After the establishment of intravenous access,the observation group and the control group were given intravenous rapid infusion of 6%hydroxyethyl starch solution 130/0.4250 ml completed within 10 min before and after spinal anesthesia,respectively.The hemodynamic parameters(heart rate,mean arterial pressure,cardiac output,left ventricular stroke volume and stroke volume variation)at left supine basic position(T_(0)),immediately after spinal anesthesia(T_(1)),during skin incision(T_(2)),during fetal delivery(T_(3)),and at the end of operation(T_(4)),as well as the incidence of complications and dosage of deoxyepinephrine were compared between the two groups.Results There were no significant differences in anesthesia level,blood loss and operation time between the two groups(P>0.05).There was no significant difference in the main effect of heart rate between groups and time points(P>0.05),and no interaction between groups and time points(P>0.05).There were statistically significant differences in the main effects of mean arterial pressure,cardiac output,left ventricular stroke volume and stroke volume variation between groups and time points(P<0.01),and there were interactions between groups and time points(P<0.01).After anesthesia,mean arterial pressure decreased in different degrees in the two groups,but the observation group was higher than the control group(P<0.05).Average arterial pressure,cardiac output and left ventricular stroke volume at T_(1),T_(2) and T_(3) after spinal anesthesia in the observation group were significantly higher than those in the control group,but stroke volume variation was significantly lower than that in the control group(P<0.05).The incidence of nausea,vomiting and hypotension in the observation group was lower than that in the control group[36.7%(11/30)vs 66.7%(20/30),30.0%(9/30)vs 63.3%(19/30)](P<0.05),and the dosage of deoxyepinephrine was lower than that in control group[(40.6±9.1)μg vs(96.9±19.2)μg](P<0.01).Conclusion Administering colloidal liquid before spinal anesthesia can increase the mean arterial pressure,cardiac output,left ventricular stroke volume and prevent hypotension more effectively,and the hemodynamics of cesarean section under spinal anesthesia is more stable.