腰硬联合麻醉对妊娠高血压综合征患者血液流变学及血流动力学影响的研究

目的观察腰硬联合麻醉(CSEA)对妊娠高血压综合征(PIHS)患者血液流变学参数及血流动力学的影响。方法将临床确诊为PIHS的180例患者随机分为CSEA组和连续硬膜外麻醉(EA)组,各90例。观察两组患者麻醉前后全血黏度及血浆黏度;检测两组患者麻醉前(T1)、麻醉后(T2)、手术开始(T3)、手术结束(T4)时的心率(HR)、收缩压(SBP)、舒张压(DBP)、心排血量(CO)、搏出指数(SI)、外周血管阻力(SVR)、左心做功(LCW)、加速度指数(ACI)及心脏指数(CI)。结果麻醉前两组全血黏度和血浆黏度比较差异无统计学意义(P>0.05),麻醉后两组全血黏度和血浆黏度比较差异有统计学意义(P<0.05)。CSEA组HR、SBP、DBP在T2、T3时较T1明显降低(P<0.05);CO、SI、SVR、LCW、CI在T2、T3、T4时较T1明显降低(P<0.05)。EA组的各项血流动力学指标在各时间点均无明显变化。两组SI、SVR、LCW、CI在T2比较差异有统计学意义(P<0.05)。结论 CSEA可改善PIHS患者血液流变学指标,但血流动力学指标不及EA稳定。

The Influence of Combined Spinal and Epidural Anesthesia on Hemorheology and Hemodynamics in Patients with Pregnancy Induced Hypertension Syndrome

Objective To observe the influence of combined spinal and epidural anesthesia(CSEA)on hemorheology and hemodynamics in patients with pregnancy induced hypertension syndrome(PIHS).Methods 180 patients with PIHS were included in this study.The patients were randomly divided into CSEA and epidural anesthesia(EA)group with 90 patients in each.The whole blood viscosity(WBV)and serum viscosity(SV)before and after anesthesia were observed.The HR,SBP,DBP,CO,SI,SVR,LCW,ACI and CI at pre-anesthesia(T1),post-anesthesia(T2),operation beginning(T3),operation ending(T4)were detected.Results The CSEA group compared with EA group,the differences of WBV and SV were not statistically significant before anesthesia(P>0.05),but were statistically significant after anesthesia(P<0.05).In CSEA group,HR,SBP,DBP were lower at T2 and T3 than those at T1(P<0.05);CO,SI,SVR,LCW and CI were lower at T2,T3,T4 than at T1(P<0.05).In EA group,there was no difference of those hemodynamics indexes at all times.ComparedThe differences of SI,SVR,LCW and CI between CSEA group and EA group were statistically significant at T2(P<0.05).Conclusion CSEA can improve the hemorheology indexes of PIHS patients,but the hemodynamic indexes are less stable than EA.