腰硬联合麻醉下不同剂量羟乙基淀粉预扩容在剖宫产术中的应用

目的:观察不同剂量羟乙基淀粉130/0.4在腰硬联合麻醉(CSEA)下预扩容行剖宫产术中的效果。方法:ASAⅠ～Ⅱ级、择期剖宫产手术病人90例,随机分为A、B、C三组,每组30例。在麻醉前30min内分别给予5ml/kg(A组)、10ml/kg(B组)、15ml/kg(C组)羟乙基淀粉130/0.4注射液。监测麻醉前、麻醉后1、5、15min和手术结束时的血流动力学,记录麻黄素用量,以及新生儿1、5minApgar评分。结果:A组术中发生低血压14例(46.7%),高于B组7例(23.3%)和C组6例(20.0%),差异有统计学意义,P<0.05;A组应用麻黄素总量分别为100mg,多于B组的63mg和C组的68mg,差异有统计学意义,P<0.05;各组新生儿1、5minApgar评分无统计学差异,p>0.05。结论:10ml/kg羟乙基淀粉130/0.4预扩容更适合应用于CSEA下行择期剖宫产术。

Effects of Different Doses of Hydroxyethyl Starch 130/0.4 as a Volume Preload before Combined Spinal and Epidural Anesthesia for Elective Caesarean Section

Objective:To evaluate the effects of different doses of Hydroxyethyl Starch 130/0.4(Voluven) as a volume preload before CSEA for elective caesarean section.Method:pregnant wemen undergoing cesarean section,ASA scored I-II,were randomly allocated into three groups:5 ml/kg of Hydroxyethyl Starch 130/0.4(group A,n=30) or 10 ml/kg of Hydroxyethyl Starch 130/0.4(group B,n=30)or 15 ml/kg of Hydroxyethyl Starch 130/0.4(group C,n=30) as a volume preload before CSEA.The incidence of hypotension,total amount of ephedrine were recorded.Mean arterial pressure(MAP) were analyzed at the different times:before anaesthesia,1,5,15min after anaesthesia and the end of operation.The Apgar score of newborns at 1,5 min were analyzed.Results:In group A,46.7% patients had hypotension,significantly higher than those of 23.3% in group B and 20% in group C(P < 0.05).The patients in group A consumed 100 mg of ephedrine more than those in group B(63 mg) and group C(68 mg).The Apgar score of newborns at 1 and 5 min among each group were normal(P >0.05)。Conclusions:Hydroxyethyl Starch 130/0.4 10 ml/kg as a Hydroxyethyl Starch 130/0.4 preload was more effective than 5 ml/kg or 15 ml/kg at preventing hypotension following CSEA for caesarean delivery.