预充不同液体对腰硬联合麻醉下急诊剖宫产孕妇血流动力学的影响

目的探讨麻醉前预充胶体液和晶体液对腰硬联合麻醉下急诊剖宫产术孕妇血流动力学的影响。方法 100例足月妊娠孕妇(ASAⅠ～Ⅱ级)随机分为晶体组(Ⅰ组)和胶体组(Ⅱ组),各50例。麻醉前分别快速输注乳酸钠林格液和羟乙基淀粉(万汶)溶液500mL,记录T1(麻醉前)、T2(麻醉后5min)、T3(胎儿娩出)、T4(胎儿娩出后5min)、T5(手术结束)的心率(HR)、收缩压(SBP)、舒张压(DBP)变化,统计麻黄碱的使用情况和观察恶心、呕吐等不良反应。结果两组产妇一般情况比较,差异无统计学意义(P>0.05)。两组组内比较,T2时的SBP、DBP较T1时明显(下降P<0.05),T2时的HR显著高于T1时(P<0.05),组间比较无统计学差异(P>0.05);两组使用麻黄碱的例数和出现恶心呕吐不良反应的发生率比较,均无统计学意义(P>0.05)。结论急诊剖宫产手术麻醉前快速输注不同液体对术中孕妇血流动力学影响无明显差异。

Hemodynamic Effects of Pre-Filling Different Liquids on Emergency Cesarean Section Maternal with Combined Spinal Epidural Anesthesia

Objective To investigate the effects of precharging colloid and crystalloid solution on hemodynamics of emergency cesarean section maternal combined with spinal-epidural anesthesia.Methods 100 cases of full-term pregnant women conformed several conditions:ASA Ⅰ ～ Ⅱ,intended for emergency caesarean operation,at the age of 20 ～ 35,weight at 50 ～ 80 Kg,who were randomly divided into crystal group(group I) and colloidal group(group II),with 50 cases in each.Before anesthesia,group I were rapidly infused with lactated Ringer's solution and group II were rapidly infused with hydroxyethyl starch(voluven) solution 500 ml.We recorded the data of heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),changes,statistics of ephedrine use and observation of nausea,vomiting and other adverse reactions on time point T 1(recorded before anesthesia 5 min),T 2(after anesthesia),T 3(fetal childbirth),T 4(5 min after delivery of the fetus),T 5(operation end).Results The data of general comparison had no statistical significance between the two groups(P >0.05).In each group,T 2 SBP,DBP was obviously lower than T 1(P <0.05),T 2 of HR were significantly higher than that of T 1(P <0.05),but without statistical differences(P >0.05) between the two groups.The data of using ephedrine cases and the rate of nausea and vomiting adverse had no statistical significance(P >0.05).Conclusions The hemodynamic data of emergency cesarean section maternal undergoing combined spinal-epidural anesthesia by prefilling different liquids has no statistical significance.