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

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0.4mL/（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、...

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Published in中国临床医学 Vol. 23; no. 6; pp. 759 - 763
Main Author 李宁 原峰 聂玉艳 解轶 符忠蓬 耿桂启 黄绍强
Format Journal Article
LanguageChinese
Published 复旦大学附属妇产科医院麻醉科,上海,200090%复旦大学附属妇产科医院产科,上海,200090%复旦大学附属妇产科医院超声科,上海,200090 2016
Subjects
低血压
剖宫产
同步负荷
胎盘循环
hypotension
placental circulation
剖宫产
低血压
cesarean
同步负荷
胎盘循环
coload
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ISSN1008-6358
DOI10.12025/j.issn.1008-6358.2016.20150659

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Summary: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0.4mL/（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5min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0.1mg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）,而RI的差异无统计学意义。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（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。
Bibliography:31-1794/R
coload; cesarean; hyp otension; placental circulation
Objective： To compare the effects of crystalloid and colloid coload on placental circulation for puerperaeunderwent spinal-epidural anesthesia and fetus. Methods ： Totally 100 cases scheduled for planned cesarean delivery underspinal anesthesia were recruited for this study. American Society of Anesthesiologists （A SA ） score was I - H. Parturientswere randomly selected into H group and R group, with 5 received 6% hydroxyethyl starch130/0. 4 sodium chloride injection, while the R group was applied with Lactated Ringer solution Two groups were receivedspeedy injection of H ES or Lactated Ringer solution before spinal-epidural anesthesia, the speed with 0. 4 0 cases in each group. H group wasmL/（kg · min） untildelivery. The dilatation stopped immediately after delivery, and puerperal received routine infusion according tohaemodynamics. Before anesthesia, 5 min after anesthesia, the systolic/diastolic ratios （S / D ）, pulsatility index （P I） andresist
ISSN:1008-6358
DOI:10.12025/j.issn.1008-6358.2016.20150659