麻醉前扩容对产妇和新生儿脐血血气分析的影响

目的：观察麻醉前扩容对产妇和新生儿脐血血气的影响。方法：ASAⅠ-Ⅱ级，孕38-40周，第1胎，择期剖宫产手术的产妇160例，随机分为4组（n=40）。A组麻醉前输注5ml/kg平衡液，B、C、C组在麻醉前分别输注5ml/kg、10ml/kg、15ml/kg万汶。输注结束后，行L3-4腰硬联合麻醉，调整麻醉平面于T6以下。术中血压下降大于基础值的30%或收缩压低于90mmHg的病例，静脉注射麻黄素10mg/次，并记录相应的给药次数。观察产妇入室（T1）、输液完成（T2）、鞘内注药5min（T3）、10min（T4）、20min（T5）时的MAP、HR、SpO2值和新生儿1min、5min的Apgqr评分。采集产妇入室后、输液完成时的动脉血，胎儿取出时的脐动脉血，行血气分析。结果：A、B组患者在T3、T4、T5各时间点的MAP值均较T1下降（P〈0.05），尤以A组的T4下降明显（P〈0.01），C、D组各时间点间无明显变化（P〉0.05）。A组麻黄碱的使用率为30%（12/40），B组为10%（4/40），两组之间有显著的统计学差异（P〈0.05），C、D组没有患者使用麻黄碱。四组产妇液体输注后的动脉血pH值、PaO2、PaCO2与输注前相比没有统计学差异（P〉0.05）；四组新生儿的脐动血气分析值和新生儿1min、5min的Apgar评分值之间均无统计学差异（P〉0.05）。结论：麻醉前扩容能够一定程度缓解产妇孕晚期的碱血症，预防母体低血压对新生儿脐血血气和Aqgar评分带来的不良影响。

The Influence of Preanesthesia Volume Expansion to Puerpera and Neonatal Umbilical Cord Blood Gas Analysis Results

Objective： To observe the influence of preanesthesia volume expansion to puerpera and neonatal umbilical cord blood gas analysis. Methods： One hundred and sixty ASA Ⅰ-Ⅱ primipara scheduled for elective Cesarean delivery were enrolled in this prospective and randomized study. Patients were randomized to Group A （preload of 5mL/kg lactated Ringer＇s solution）, Group B （preload of 5ml/kg Voluven）, Group C（preload of 10 ml/kg Voluven） or Group D（preload of 15 ml/kg Voluven）. After infusion, performed L3-4 Spinai-epidural anesthesia and level below T6. Intravenous Ephedrine 10mg/times when Systolic pressure less than 90mmHg or 70% of baseline, record the times of drug given. Mean arterial blood pressure, Heart rate, Saturation of pulse blood oxygen were recorded upon entering the operating room （T1）, after infusion（T2）, 5min （T3）, 10min （T4）, 20min （T5） after injection of the anesthetic, as well as lmin, 5rain Apgar Scores. Blood gas analysis were performed before and after infusion, as well as the umbilical artery blood. Result：： MAP in group A and group B at T3, T4, T5 were lower than that of T1 （p〈0.05）, especially in group A at T4（p〈0.01）. There is no significant difference between group C and group D（p〉0.05）. The application proportion of Ephedrine was 30%（12/40） in group A and 10%（4/40） in group B, which has statistical differences between groups（p〈0.05）. No patients received Ephedrine in group C and D. There were no statistical differences of Apgar scores among four groups either 1-min or 5-min （p〉0.05）. Still there were no difference of Blood gas analysis （include pH,PaO2,PaCO2,BE）. Conclusion： Preanesthesia volume expansion can ease alkalemia in late trimester pregnancy to some degrees, and can prevent the adverse effect on the umbilical artery Blood gas analysis and Apgar scores contribute to the maternal hypotension.