重度子痫前期剖宫产围术期血流动力学的变化及液体治疗的影响

目的 探讨子痫前期剖宫产围术期的血流动力学变化，明确液体治疗对其影响。方法 收集首都医科大学附属北京妇产医院2012年2月～2013年10月择期行剖宫产手术的子痫前期孕产妇30例。按输入溶液不同将其分为A、B、C三组，每组各10例。A组孕产妇给予传统限液，B组孕产妇给予胶体液（6％羟乙基淀粉130／0．4氯化钠注射液）；C组孕产妇给予晶体液（乳酸钠林格注射液），监测并记录围术期各时间点血流动力学指标的变化情况，包括心输出量（CO）、心脏指数（CI）、每搏量（SV）、每搏指数（SVI）、全身血管阻力（SVR）及收缩压（SYS）、舒张压（DIA）、平均动脉压（MAP）。结果 ①组间比较，T2、T7、T10和T11时，B组的SYS、DIA和MAP在上述时点比较，差异均无统计学意义（P〉0．05）（提示B组各指标较稳定），A组SYS、DIA和MAP在各时点比较．差异均有统计学意义（P〈0．05）（提示A组各指标不稳定），可见，B组SYS、DIA和MAP在各时间点比A组稳定。在其他时点时差异无统计学意义（P〉0．05）。A组HR值比B组和C组都快，在T5和T7-T11，时明显（P〈0．05），T12和T13时A组比B组快（P〈0．05）。三组间CO、CI、SV、SVI、CVP在各时点差异无统计学意义（P〉0．05）；B组SVR比C组各时点都低，在T6～T8和T11时明显（P〈0．05），其他各点B组SVR与C组比较差异无统计学意义（P〉0．05）。②各组内比较，以T0为对照，A组SYS、DIA和MAP在T2和T6-T11时明显降低（P〈0．05）；B组和C组各时点差异无统计学意义（P〉0．05）。以T0为对照，三组内CO、CI、SV、SVI在各时点变化差异无统计学意义（P〉0．05）；B组SVR值和C组在各时点变化差异无统计学意义（P〉0．05）。结论 重度子痫前期剖宫产患者围术期，限液对患者的循环影响较大。麻醉前的液体治疗既安全又可使子痫前期患者围术期的循环稳定。其中麻醉前胶体液治疗效果更突出。

Changes and influence on the liquid medicine study of severe preeclampsia cesarean delivery woman perioperative hemodynamic

Objective To study the perioperative hemodynamics variations of severe pre-eelampsia and fluid treat. Methods 30 cases of maternal preeclampsia cesarean delivery with elective cesarean delivery operation from February 2012 to October 2013 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University were collected and divided into group A, group B, group C according to the different input solution with 10 cases in each group. Group A of maternal was given traditional limit liquid, group B maternal was given colloid （130/0.4 6% hydroxyethyl starch and sodium chloride injection）; group C maternal was given liquid crystal salinger （sodium lactate injection）, the perioperarive changes of hemodynamie parameters each time point, including cardiac output （CO）, cardiac index （CI）, stroke volume （SV）, stroke index （SVI）, systemic vascular resistance （SVR） and （systolic blood pressure （SYS）, diastolic blood pressure （DIA）, mean arterial pressure （MAP） were monitored and recorded. Results ①At T2, T7, T8, T10 and T11, group B of SYS, DIA, and MAP in the point above comparison, there were no statistically significant differences （P 〉 0.05） （prompting that the index in group B was relatively stable）; group A of SYS, DIA, and the MAP in every point, the differences were statistically significant （prompting that the index in group A was relatively unstable）, so that, group B of SYS, DIA, and the MAP were more stable than group A at the above time points （P 〈 0.05）. There were no statistical significance in other times （P 〉 0.05）. HR of group A was faster than group B and C, especially at T5 and T7-T11 （P 〈 0.05）. HR were more of group A than group B at T12-T13. There were no statistical significance with CO, CI, SV, SVI and CVP with the group comparisons （P 〉 0.05）. SVR were lower of group B than group A at every time, especially at T6-T8, T11 （P 〈 0.05）. All other points in group B of SVR, there was no statistically significant difference compared with group C （P 〉 0.05）. ②Group-in comparison showed that, TO as the comparison point,the SYS, DIA and MAP of group A were dropped obviously at T2, T6-T11 （P 〈 0.05）. There were no statistical significance in other times of group B and group C （P 〉 0.05）. To as the comparison point, there were no statistical significance with CO, CI, SV, SVI with the group comparisons （P 〉 0.05）. There were no statistical significance of SVR in other times of group B and group C （P 〉 0.05）. Conclusion There are obviously circulation fluctuation during perioperation of severe pre-eclampsia. The preoperative fluid therapy can securely maintain circulation stabilized, especially the colloid solution.