脉搏灌注指数对去氧肾上腺素预处理防治剖宫产腰麻后低血压的影响

Effect of pulse perfusion index on the prevention and treatment of hypotension after cesarean section by deoxyadrenalin pretreatment

目的观察脉搏灌注指数(PI)对去氧肾上腺素预处理防治剖宫产腰麻后低血压的影响。方法选取80例拟在腰硬联合麻醉下行剖宫产术的产妇,根据术前PI值分为HI组(PI>4)45例和LI组(PI<4)35例。实施腰硬联合麻醉,麻醉成功后给予产妇去氧肾上腺素加入乳酸钠林格注射液中持续静脉输注,比较两组一般资料、麻醉前后血流动力学指标、不良反应发生情况及新生儿的Apgar评分、血pH、血乳酸值和血清神经元特异性烯醇化酶(NSE)浓度。结果麻醉前,两组收缩压、舒张压和心率水平比较差异无统计学意义(P>0.05);麻醉后5 min和胎儿取出后5 min,两组收缩压、舒张压和心率水平均较麻醉前改善,且LI组优于HI组,差异有统计学意义(P<0.05)。LI组高血压、低血压、心动过速、心动过缓、恶心呕吐等不良反应总发生率低于HI组,差异有统计学意义(P<0.05)。LI组新生儿的血pH高于HI组,血乳酸值、血清NSE浓度均低于HI组,差异有统计学意义(P<0.05)。结论PI可以预测在去氧肾上腺素预处理条件下的低血压(PSH)发生率;高PI产妇更易发生PSH、新生儿血pH降低、血乳酸值增加、血清NSE增加。可根据PI值选择性使用血管活性药物预防和治疗围术期的血流动力学紊乱。

Objective To observe the effect of Pulse perfusion index(PI)on hypotension after cesarean section and lumbar anesthesia treated by deoxyadrenalin.Methods A total of 80 women who were going to have cesarean section under combined epidural anesthesia were selected and divided into HI group(45 cases)(PI>4)and LI group(35 cases)(PI<4)according to preoperative PI values.Combined epidural anesthesia was performed.After successful anesthesia,the parterient was added to the breast sodium Ringer's fluid for continuous intravenous infusion.General data,hemodynamic indexes before and after anesthesia,adverse reactions,Apgar score,pH value,blood lactic acid value and serum neuron-specific enolase(NSE)concentration of the two groups were compared.Results Before anesthesia,there were no significant differences in systolic blood pressure,diastolic blood pressure and heart rate between the two groups(P>0.05).5 min after anesthesia and 5 min after fetal extraction,systolic blood pressure,diastolic blood pressure and heart rate in both groups were improved compared with those before anesthesia,and LI group was better than HI group,the difference was statistically significant(P<0.05).The total incidence of hypertension,hypotension,tachycardia,bradycardia,nausea and vomiting in LI group was lower than that in HI group,and the difference was statistically significant(P<0.05).The blood pH value of neonates in LI group was higher than that in HI group,and the blood lactic acid value and blood NSE concentration were lower than those in HI group,with statistical significance(P<0.05).Conclusion PI can predict the incidence of hypotension(PSH)in the condition of deoxyadrenalin pretreatment;Women with high PI are more likely to develop PSH,lower blood pH,increase blood lactic acid and increase blood NsE.Vasoactive agents can be selectively used to prevent and treat perioperative hemodynamic disturbances based on PI values.