腹式呼吸操对腰麻剖宫产产妇发生仰卧位低血压综合征及胎儿的影响

Effects of 3-2-3 abdominal breathing exercises on supine hypotension syndrome and fetus after subarachnoid block in caesarean section parturients

目的探讨3-2-3腹式呼吸操对腰麻后剖宫产产妇发生仰卧位低血压综合征(SHS)及胎儿的影响。方法将131例剖宫产产妇用随机数字表法分为对照组44例、腹式深呼吸组(深呼吸组)43例和3-2-3腹式呼吸操组(3-2-3组)44例。腰麻后平卧,对照组无干预;深呼吸组行深呼吸鼓腹;3-2-3组按吸气计数1、2、3腹部鼓至最高,屏气计数1、2,再呼气计数1、2、3至腹部降至最低方式呼吸。记录3组麻醉前(T_(0))、麻醉后仰卧5 min(T_(1))、手术前即刻(T_(2))、胎儿娩出前(T_(3))、胎儿娩出后(T_(4))的心率(HR)和T_(0)、T_(1)时收缩压(SBP)、平均动脉压(MAP)变化;比较3组产妇不良反应发生率、升压药使用率、SHS发生率、呼吸坚持时长及新生儿1 min、5 min的Apgar评分。采集脐动脉血并检测白细胞介素(IL)-1、IL-6、肿瘤坏死因子α(TNF-α)、皮质醇(Cor)、去甲肾上腺素(NE)、pH值、乳酸(Lac)、碱剩余(BE)等指标。结果(1)对照组T_(1)—T_(4)时、深呼吸组T_(1)和T_(3)时HR较T_(0)时变化明显(P<0.05),3-2-3组T_(1)—T_(4)时HR较对照组波动减小(P<0.05);T_(1)时对照组、深呼吸组的SBP和MAP较T_(0)时下降(P<0.05),而3-2-3组MAP无明显改变(P>0.05)。(2)与对照组比较,3-2-3组不良反应和SHS发生率、升压药使用率下降,新生儿Apgar评分增高;3-2-3组呼吸坚持时长较深呼吸组和对照组延长(P<0.05)。(3)与对照组相比,3-2-3组脐动脉血IL-1、IL-6、TNF-α、Cor、NE、pH值、Lac、BE均明显改善(P<0.05);与深呼吸组相比,3-2-3组IL-6、TNF-α、pH值、Lac、BE有明显差异(P<0.05)。结论以3-2-3腹式呼吸操指导腰麻后剖宫产产妇可降低SHS发生率,抑制胎儿应激反应和酸中毒,优于腹式深呼吸法。

Objective To discuss the effect of 3-2-3 abdominal breathing exercises on the occurrence of supine hypotension syndrome(SHS)and fetus in women with caesarean section after subarachnoid block.Methods A total of 131 cesarean section women were selected and randomly divided into three groups:the control group,the deep breathing group and the 3-2-3 abdominal breathing exercise group(3-2-3 group),with 44,43 and 44 cases in each group.After subarachnoid block,the postpartum women were lied flat and received the following treatment:the control group received no intervention,the deep breathing group only instructed deep breathing and abdominal distension and in the 3-2-3 group inhalation counted 1,2 and 3 with abdominal bulge to the highest,holding counts 1,2 and with exhalation counted 1,2 and 3 until the abdomen reaches the lowest.Changes of heart rates(HR)before anesthesia(T_(0)),supine position for 5 minutes after anesthesia(T_(1)),immediately before surgery(T_(2)),before fetal removal(T_(3)),after fetal removal(T_(4)),as well as systolic blood pressure(SBP),mean arterial pressure(MAP)at T_(0) and T_(1) were recorded in the three groups.The occurrence of adverse reactions,the use rate of vasopressors,incidence of SHS,duration of respiratory persistence and Apgar scores of 1-minute and 5-minute in newborns were compared between the three groups.Umbilical artery blood was collected,and interleukin(IL)-1,IL-6 and tumor necrosis factor alpha(TNF-α),cortisol(Cor),norepinephrine(NE),pH value,lactate(Lac)and buffuer excess(BE)were detected.Results(1)Compared to the control group,the HR at T_(1) to T_(4) showed significant changes in the deep breathing group(P<0.05),while the HR at T_(1) to T_(4) of the 3-2-3 group showed less fluctuation compared to the control group(P<0.05).SBP and MAP of the control group and the deep breathing group significantly decreased at T_(1)(P<0.05),but there was no significant change in MAP in the 3-2-3 group(P>0.05).(2)Compared with the control group,the incidence of adverse reactions and SHS,as well as the use of vasopressors decreased obviously in the 3-2-3 group(P<0.05),and Apgar score of newborns increased(P<0.05).The respiratory persistence duration was longer in the 3-2-3 group than that in the deep breathing group and the control group(P<0.05).(3)Compared to the control group,there were significant improvements in IL-1,IL-6,TNF-α,Cor,NE,pH,Lac and BE in the 3-2-3 group(all P<0.05).Compared to the deep breathing group,there were significant differences in IL-6,TNF-α,pH value,Lac and BE in the 3-2-3 groups(P<0.05).Conclusion The 3-2-3 abdominal breathing exercises can reduce the incidence of SHS,inhibit fetal stress response and acidosis,and is superior to abdominal deep breathing method in women with cesarean section after subarachnoid block.