妊娠期高血压患者围术期血容量变化及液体治疗效果分析

Changes of perioperative blood volume and fluid therapy in patients with gestational hypertension

目的了解妊娠期高血压患者围术期血容量变化特点,探讨液体治疗效果。方法选取2019年1月—2021年6月在绍兴市妇幼保健院就诊的100例剖宫产孕妇,其中健康足月妊娠孕妇50例(N组),合并妊娠期高血压孕妇50例(H组)。测量下腔静脉最大直径(IVCmax)和下腔静脉最小直径(IVCmin),计算下腔静脉塌陷指数(cIVC),评价患者血容量状态。结果两组各时间点cIVC比较差异均无统计学意义(均P>0.05),两组术后12、30、48、54、66 h IVCmax比较差异均有统计学意义(均P<0.05)。手术结束时、术后6和24 h时,H组围术期血容量过多发生率显著高于N组(均P<0.05)。N组手术结束时血容量不足发生率最高。H组仅手术结束时2例存在血容量不足。结论围术期限制性液体输注策略下,妊娠期高血压患者较正常妊娠孕妇更多表现出血容量过多。

Objective To understand the changes of perioperative blood volume in patients with gestational hypertension,and explore fluid therapy strategies.Methods One hundred pregnant women with cesarean delivery from Shaoxing Maternity and Child Health Care Hospital from January 2019 to June 2021 were selected,including 50 healthy full-term pregnant women(group N)and 50 pregnant women with gestational hypertension(group H).The maximum diameter of the inferior vena cava(IVCmax)and the minimum diameter of the inferior vena cava(IVCmin)were measured,the inferior vena cava collapse index(cIVC)was calculated to evaluate blood volume status of the patients.Results There was no statistically significant difference in cIVC between the two groups at each time point(all P>0.05),and there were statistically significant differences in IVCmax at 12,30,48,54,and 66 hours after operation between the two groups(all P<0.05).The incidence rates of perioperative volume overload in group H were significantly higher than those in group N at the end of surgery,6 hours and 24 hours after operation(all P<0.05).Group N had the highest incidence rate of volume underload at the end of surgery.Group H had only 2 cases of volume underload at the end of surgery.Conclusion The patients with gestational hypertension treated with perioperative restrictive fluid infusion strategies exhibit excess blood volume compared with healthy pregnant women.