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不同液体扩容方案对脊髓硬膜外麻醉后产妇子宫胎盘循环的影响

  • 摘要: 目的:探讨不同液体扩容方案对脊髓硬膜外麻醉后剖宫产产妇子宫胎盘循环及胎儿的影响。方法:选择择期在脊髓硬膜外麻醉下行剖宫产手术的产妇100例,美国麻醉师协会(American Society of Anesthesiologists,ASA)评分为Ⅰ~Ⅱ级。采用随机数字表法将产妇分为H组、R组,每组50例。H组产妇采用6%羟乙基淀粉130/0.4氯化钠注射液(HES);而R组产妇采用乳酸林格液。两组产妇于脊髓硬膜外麻醉注药前即刻分别快速静脉滴注(同步负荷)HES或乳酸林格液至胎儿娩出,输注速率为0.4 mL/(kg·min)。胎儿娩出后即停止扩容,同时根据产妇血流动力学情况常规补液。麻醉前、麻醉后5 min采用彩色多普勒超声测量脐血流收缩期最大血流速度/舒张期最大血流速度(S/D)、搏动指数(PI)、阻力指数(RI)值。胎儿娩出后,抽取脐动脉和脐静脉血进行血气分析,并比较胎儿的Apgar评分。术中低血压以去氧肾上腺素0.1 mg处理。结果:脊髓硬膜外麻醉后,两组胎儿的脐动脉PI和S/D值均降低(P<0.05),〖BP(〗H组S/D值明显低于R组(P=0.04),〖BP)〗而RI的差异无统计学意义〖BP(〗(P>0.05)〖BP)〗。RI值无论是麻醉前后还是两组间的差异均无统计学意义。术中H组低血压发生率低于R组(〖BP(〗32% vs 60% ,〖BP)〗P=0.03)。R组去氧肾上腺素使用量高于H组(P=0.001)。两组新生儿血气分析和Apgar评分差异均无统计学意义。结论:脊髓硬膜外麻醉使脐血流阻力降低;与乳酸林格液比较,胶体液同步负荷显著增加子宫胎盘灌注,术中低血压发生率低。

     

    Abstract: Objective:To compare the effects of crystalloid and colloid coload on placental circulation for puerperae underwent spinalepidural anesthesia and fetus. Methods:Totally 100 cases scheduled for planned cesarean delivery under spinal anesthesia were recruited for this study. American Society of Anesthesiologists (ASA) score was ⅠⅡ. Parturients were randomly selected into H group and R group, with 50 cases in each group. H group was received 6% hydroxyethyl starch 130/0.4 sodium chloride injection, while the R group was applied with Lactated Ringer solution. Two groups were received speedy injection of HES or Lactated Ringer solution before spinalepidural anesthesia, the speed with 0.4 mL/(kg·min) until delivery. The dilatation stopped immediately after delivery, and puerperal received routine infusion according to haemodynamics. Before anesthesia, 5 min after anesthesia, the systolic/diastolic ratios (S/D), pulsatility index (PI)and resistance index (RI)were detected by using color Doppler ultrasound. After delivery, the umbilical artery blood and umbilical veins blood were analyzed, and the Apgar scores were compared. Phenylephrine 0.1 mg was applied for hypotension during surgery. Results:After spinalepidural anesthesia, the umbilical artery PI and S/D in two groups were reduced. There was no statistical significance of RI between before anesthesia and after anesthesia or between two groups. The incidence of hypotension during surgery in H group was lower than that in R group (P=0.03). The phenylephrine requirements in R group was higher than that in H group (P=0.001). There was no statistical significance of blood gas analysis and Apgar score in two groups. Conclusions:The spinalepidural anesthesia can lower the resistance of umbilical artery blood. Comparing to Lactated Ringer′s solution, colloid coload significantly increased placental perfusion, and decrease the incidence rate of hypotension during surgery.

     

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