腰硬联合麻醉下剖宫产术中左侧斜卧位对产妇血流动力学的影响

目的：观察腰硬联合麻醉下剖宫产术中体位变化对产妇血流动力学的影响。方法将40例ASAⅠ～Ⅱ级拟行剖宫产术的产妇分为A、B两组，每组20例，于剖宫产术中分别采用平卧位和左侧斜卧15°位。分别于入室后5 min、腰硬联合麻醉时侧卧位后3 min、麻醉后3 min、切皮即刻、胎儿娩出后3 min、手术结束时点记录产妇心输出量、每搏量、心率、平均动脉压、总外周阻力、胸腔液体含量。结果两组产妇总输液量、升压药用量、心率、胸腔液体含量无明显差异；心输出量、每搏量组内各时比较点差异有统计学意义（P＜0.05），但组间比较差异无统计学意义（P＞0.05）；麻醉后A组血压、总外周阻力下降较B组明显（P＜0.05）。结论腰硬联合麻醉剖宫产术围术期血流动力学波动较大，主要发生在麻醉后及胎儿娩出前后，需要及时准确的监测以指导治疗。术中采取左侧斜卧位，配合恰当的容量治疗及麻醉管理，可减少低血压的发生。

Effect of left tilt 15-degree position on the hemodynamic changes during cesarean section under combined spinal-epidural anesthesia

Objective To investigate the effect of left tilt 15-degree position on hemodynamic changes with the non-invasive hemodynamic monitor ( NICOM) during cesarean section under combined spinal -epidural anesthesia. Methods 40 ASAⅠ-Ⅱpuerperas undergoing cesarean section under combined spinal-epidural anesthesia were en-rolled and divided into supine group and left tilt 15-degree group randomly.Hemodynamic parameters including cardiac output, stroke volume, mean arterial pressure, heart rate, total peripheral vascular resistance, and thoracic fluid content were recorded at 6 time points by NICOM system: baseline, 3 min after lateral position, 3 min after spinal anesthesia, skin incision, 3 min after delivery, end of operation.Results No significant difference between two groups were observed in total infusion, usage of vasoactive drugs, heart rate and thoracic fluid content (P>0.05).Cardiac output and stroke volume showed statistically significant differences at various time points within each group ( P<0.05 ) but not between groups(P>0.05).Blood pressure and total peripheral resistance in the supine group were significantly decreased when compared with the left tilt group after anesthesia ( P<0.05 ) .Conclusion There is dramatic hemodynamic fluctuation during cesarean section under combined spinal-epidural anesthesia, which mainly occurs after anesthesia and around de-livery of the baby, and it needs to be monitored real-time and accurately.Assuming a left tilt 15-degree position with proper fluid therapy and anesthesia management can minimize hypotension occurrence.